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Title: More Intensive Dialysis Does Not Improve Outcomes Among Patients With Acute Kidney Injury
URL: http://www.pslgroup.com/dg/221D26.htm
Doctor's Guide
May 22, 2008

BETHESDA, Md -- May 22, 2008 -- A study recently published in the New England Journal of Medicine reported no significant difference in death rates or other outcomes between a group of patients with acute kidney injury receiving intensive dialysis and another group receiving a more standard regimen of dialysis. Acute kidney injury is a common complication in hospitalised patients and is associated with very high mortality rates. In-hospital mortality rates of critically ill patients typically range from 50% to 80%.

Several prior single-centre studies in patients with acute kidney injury had suggested improved survival with more intensive dialysis, which is significantly more costly to administer. "We now have definitive evidence that intensive treatment of acute kidney injury is no more beneficial in improving treatment outcomes than the usual level of care," said Elias A. Zerhouni, MD, Director, National Institutes of Health (NIH) Bethesda, Maryland. "As a result, the findings of this well-designed study may help prevent unnecessary medical expenditures."

In this study, doctors provided renal-replacement therapy to both patient groups. Patients who did not require medications to maintain their blood pressure were treated with conventional dialysis, either 3 times per week in the less intensive arm of the study or 6 times per week in the intensive arm. Patients who were unstable and required medications to increase their blood pressure were treated with more gentle forms of dialysis, either sustained low-efficiency dialysis (SLED) -- a slower form of hemodialysis -- or a continuous form at a lower or higher doses as randomly assigned. Patients were able to switch between forms of therapy as their clinical condition changed, while remaining within the lower- or higher-intensity treatment arms of the study.

Within 60 days after starting dialysis, 302 patients in the intensive treatment group died compared with 289 patients in the less intensive treatment group. Also, the study reports no significant differences between the 2 groups in recovery of kidney function, the rate of failure of organs other than kidneys, or the number of patients able to return to their prior living situations.

"Unlike earlier studies that used only a single method of therapy, our use of an integrated strategy of continuous and intermittent methods of therapy allows us to apply these study results more readily to clinical practice," explained study chair Paul M. Palevsky, MD, Chief, Renal Section, Veterans Affairs Pittsburgh Healthcare System, and Professor of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. "What is important about these results is that they outline the limits of effective therapy."


SOURCE: US National Institutes of Health

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