Joerg C Schefold, Stephan von Haehling, Rene Pschowski, Thorsten Onno Bender, Cathrin Berkmann, Sophie Briegel, Dietrich Hasper, Achim Jörres Critical Care 2014, 18:R11 (10 January 2014)
Introduction: Acute renal failure (ARF) requiring renal replacement therapy (RRT) occurs frequently in ICU patients and significantly affects mortality rates. Previously, few large clinical trials investigated the impact of RRT modalities on patient outcomes. Here we investigate the effect of two major RRT strategies (intermittent hemodialysis (IHD) and continuous veno-venous hemofiltration (CVVH)) on mortality and renal-related outcome measures.
Methods: This single-center prospective randomized controlled trial ("CONVINT") included 252 critically ill patients (159 male, mean age 61.5 +/- 13.9 years, Acute Physiology and Chronic Health Evaluation (APACHE) II score 28.6 +/- 8.8) with dialysis-dependent ARF treated in the ICUs of a tertiary care academic center. Patients were randomized to receive either daily IHD or CVVH. The primary outcome measure was survival at 14 days after the end of RRT. Secondary outcome measures included 30-day-, intensive care unit- and intra-hospital mortality as well as course of disease severity/biomarkers and need for organ support therapy.
Results: At baseline, no differences in disease severity, distribution of age and gender, or suspected reason of acute renal failure were observed. Survival rates at 14 days after RRT were 39.5% (IHD) versus 43.9% (CVVH) (odds ratio (OR) 0.84, 95% confidence interval (CI) 0.49 to 1.41; P = 0.50). 14-day-, 30-day, and all-cause intra-hospital mortality rates were not different between the two groups (all P >0.5). No differences were observed in days on RRT, vasopressor days, days on ventilator or ICU-/ intra-hospital length of stay.
Conclusions: In a monocentric RCT, we observed no statistically significant differences between the investigated treatment modalities regarding mortality, renal-related outcome measures, or survival at 14 days after RRT. Our findings add to mounting data demonstrating that intermittent and continuous RRTs may be considered equivalent approaches for critically ill patients with dialysis-dependent acute renal failure.
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