Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial

Whether continuous renal replacement therapy is better than intermittent haemodialysis for the treatment of acute renal failure in critically ill patients is controversial. In this study, we compare the effect of intermittent haemodialysis and continuous venovenous haemodiafiltration on survival rat...

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Published in:The Lancet (British edition) 2006-07, Vol.368 (9533), p.379-385
Main Authors: Vinsonneau, Christophe, Camus, Christophe, Combes, Alain, Costa de Beauregard, Marie Alyette, Klouche, Kada, Boulain, Thierry, Pallot, Jean-Louis, Chiche, Jean-Daniel, Taupin, Pierre, Landais, Paul, Dhainaut, Jean-François
Format: Article
Language:English
Subjects:
Acute Kidney Injury - therapy
Aged
Clinical trials
Female
Hemodiafiltration - adverse effects
Hemodiafiltration - methods
Hemodialysis
Humans
Intensive Care Units
Length of Stay
Male
Medical disorders
Methods
Middle Aged
Multiple Organ Failure - mortality
Patients
Renal Dialysis - adverse effects
Renal Dialysis - methods
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Summary:Whether continuous renal replacement therapy is better than intermittent haemodialysis for the treatment of acute renal failure in critically ill patients is controversial. In this study, we compare the effect of intermittent haemodialysis and continuous venovenous haemodiafiltration on survival rates in critically ill patients with acute renal failure as part of multiple-organ dysfunction syndrome. Our prospective, randomised, multicentre study took place between Oct 1, 1999, and March 3, 2003, in 21 medical or multidisciplinary intensive-care units from university or community hospitals in France. Guidelines were provided to achieve optimum haemodynamic tolerance and effectiveness of solute removal in both groups. The two groups were treated with the same polymer membrane and bicarbonate-based buffer. 360 patients were randomised, and the primary endpoint was 60-day survival based on an intention-to-treat analysis. Rate of survival at 60-days did not differ between the groups (32% in the intermittent haemodialysis group versus 33% in the continuous renal replacement therapy group [95 % CI −8·8 to 11·1,]), or at any other time. These data suggest that, provided strict guidelines to improve tolerance and metabolic control are used, almost all patients with acute renal failure as part of multiple-organ dysfunction syndrome can be treated with intermittent haemodialysis.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(06)69111-3