Intensity of RRT in Critically Ill Patients

NEJM

October 22, 2009

Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

What was the research question?

  • Does higher intensity dialysis compared to lower intensity dialysis reduce 90-day mortality in critically ill adults requiring renal replacement therapy?


How did they do it?

  • A multicenter randomized trial in 35 ICUs in Australia and New Zealand.

  • 1508 critically ill adults with acute kidney injury requiring continuous renal-replacement therapy were randomized to receive a high-intensity with an effluent flow of either 40 ml/kg/hour (747 patients) or a low-intensity with an effluent flow of 25 ml/kg/hour (761 patients).

  • The primary outcome measure was death within 90 days after randomization.


What did they find?

  • 90-day mortality was not significantly different between the high intensity group and the low intensity group (44.7% in each group, P=0.99).

  • The need of RRT in survivors at 90 days was not significantly different between the high-intensity group and the low-intensity group (6.8% vs. 4.4%, P=0.14).

  • Hypophosphatemia was more common in the high-intensity group than in the low-intensity group (65% vs. 54%, P<0.001).

  • There was no difference in the mortality in the pre-determined subgroup analysis of patients with severe sepsis which made up about 49.4% of patients.


Are there any limitations?

  • The delivered dose of treatment was less than the prescribed dose.

  • Unblinded study with potential for bias.

  • The study used mixed diffusive and convective clearance method without examining if one is better than the other.


What does it mean?

  • Mortality at 90 days was not better with higher-intensity continuous renal-replacement therapy in critically ill patients with acute kidney injury.

  • No need to use higher dose of renal replacement therapy.

Intensity of RRT in Critically Ill Patients