Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury.
Stéphane Gaudry, Marouane Boubaya, Guillaume Louis et al.
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In 30 seconds
This multicenter, open-label, randomized noninferiority trial compared intermittent hemodialysis with continuous renal-replacement therapy as initial treatment in critically ill adults with acute kidney injury and indications for renal-replacement therapy. The trial stopped early after interim analyses indicated a sustained mortality signal with intermittent treatment. By day 90, the primary composite kidney outcome occurred in 78.1% versus 71.6%, respectively; intermittent hemodialysis was not shown to be noninferior. Day-90 mortality estimates were 63.3% with intermittent and 53.6% with continuous therapy (hazard ratio, 1.30; 95% CI, 1.04 to 1.63).
Key findings
- The day-90 major adverse kidney event occurred in 78.1% with intermittent hemodialysis and 71.6% with continuous therapy (adjusted absolute risk difference, 6.28 percentage points; 95% CI, -1.22 to 13.79).
- Day-90 Kaplan-Meier mortality estimates were 63.3% and 53.6%, respectively (hazard ratio, 1.30; 95% CI, 1.04 to 1.63).
- Hypotension occurred in 68.8% of the intermittent group and 66.5% of the continuous group.
Why it matters
The findings address uncertainty about the initial renal-replacement approach in critically ill patients with acute kidney injury. The higher observed mortality with intermittent hemodialysis, alongside failure to establish noninferiority for the composite kidney outcome, makes the choice of modality clinically consequential. Interpretation should account for the trial’s early stopping and the fact that the reported results concern initial treatment in this critically ill population.
What to keep in mind
The trial stopped early after interim analyses showed a mortality signal, which may limit interpretation of the comparative outcomes.