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      Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit.

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          Abstract

          The timing of renal-replacement therapy in critically ill patients who have acute kidney injury but no potentially life-threatening complication directly related to renal failure is a subject of debate.

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

          K Beauregard, Christophe Vinsonneau, Christophe Camus … (2006)
          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.
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            Daily hemodialysis and the outcome of acute renal failure.

            V. Lang, Rainald Fischer, Helmut Schiffl (2002)
            Intermittent hemodialysis is widely used as renal-replacement therapy in patients with acute renal failure, but an adequate dose has not been defined. We performed a prospective study to determine the effect of daily intermittent hemodialysis, as compared with conventional (alternate-day) intermittent hemodialysis, on survival among patients with acute renal failure. A total of 160 patients with acute renal failure were assigned to receive daily or conventional intermittent hemodialysis. Survival was the primary end point of the study. The duration of acute renal failure and the frequency of therapy-related complications were secondary end points. The two study groups were similar with respect to age, sex, cause and severity of acute renal failure, medical or surgical intensive care setting, and the score on the Acute Physiology, Age, and Chronic Health Evaluation. Daily hemodialysis resulted in better control of uremia, fewer hypotensive episodes during hemodialysis, and more rapid resolution of acute renal failure (mean [+/-SD], 9+/-2 vs. 16+/-6 days; P=0.001) than did conventional hemodialysis. The mortality rate, according to the intention-to-treat analysis, was 28 percent for daily dialysis and 46 percent for alternate-day dialysis (P=0.01). In a multiple regression analysis, less frequent hemodialysis (on alternate days, as opposed to daily) was an independent risk factor for death. The high mortality rate among critically ill patients with acute renal failure who require renal-replacement therapy is related to both coexisting conditions and uremic damage to other organ systems. Intensive hemodialysis reduces mortality without increasing hemodynamically induced morbidity.
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              Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: A prospective, randomized trial

              Catherine S C Bouman, Heleen Oudemans-van Straaten, Jan Tijssen … (2002)
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                Author and article information

                Journal
                Journal ID (iso-abbrev): N. Engl. J. Med.
                Title: The New England journal of medicine
                ISSN (Electronic): 1533-4406
                ISSN (Print): 0028-4793
                Publication date (Electronic): Jul 14 2016
                Volume: 375
                Issue: 2
                Affiliations
                [1 ] From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers,
                Article
                DOI: 10.1056/NEJMoa1603017
                PubMed ID: 27181456
                SO-VID: d5eb1b2d-0f3a-4ca2-bad8-d554175c1cc0
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