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Intensity of renal support in critically ill patients with acute kidney injury.

Publication ,  Journal Article
VA/NIH Acute Renal Failure Trial Network, ; Palevsky, PM; Zhang, JH; O'Connor, TZ; Chertow, GM; Crowley, ST; Choudhury, D; Finkel, K; Kellum, JA ...
Published in: N Engl J Med
July 3, 2008

BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour. RESULTS: Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P=0.47). There was no significant difference between the two groups in the duration of renal-replacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups. CONCLUSIONS: Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

July 3, 2008

Volume

359

Issue

1

Start / End Page

7 / 20

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Renal Dialysis
  • Multiple Organ Failure
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Hemodiafiltration
  • General & Internal Medicine
 

Citation

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VA/NIH Acute Renal Failure Trial Network, ., Palevsky, P. M., Zhang, J. H., O’Connor, T. Z., Chertow, G. M., Crowley, S. T., … Peduzzi, P. (2008). Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med, 359(1), 7–20. https://doi.org/10.1056/NEJMoa0802639
VA/NIH Acute Renal Failure Trial Network, Peter, Paul M. Palevsky, Jane Hongyuan Zhang, Theresa Z. O’Connor, Glenn M. Chertow, Susan T. Crowley, Devasmita Choudhury, et al. “Intensity of renal support in critically ill patients with acute kidney injury.N Engl J Med 359, no. 1 (July 3, 2008): 7–20. https://doi.org/10.1056/NEJMoa0802639.
VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008 Jul 3;359(1):7–20.
VA/NIH Acute Renal Failure Trial Network, Peter, et al. “Intensity of renal support in critically ill patients with acute kidney injury.N Engl J Med, vol. 359, no. 1, July 2008, pp. 7–20. Pubmed, doi:10.1056/NEJMoa0802639.
VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RMH, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008 Jul 3;359(1):7–20.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

July 3, 2008

Volume

359

Issue

1

Start / End Page

7 / 20

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Renal Dialysis
  • Multiple Organ Failure
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Hemodiafiltration
  • General & Internal Medicine