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.