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Title: Haemofiltration Better Than Peritoneal Dialysis In Infection-Related Renal Failure

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N Engl J Med 2002;347:895-902
09/19/2002 12:59:20 PM
By Anne MacLennan

Haemofiltration is superior to peritoneal dialysis for treatment of infection-associated acute renal failure in terms of both clinical outcome and cost. This is the conclusion of an international randomised trial comparing acute peritoneal dialysis with haemofiltration in patients with severe acute renal failure related to infection. Until now, the relative efficacy of the two procedures has been unknown. Acute renal failure is a major contributor to the morbidity and mortality linked with severe infection. In resource-rich countries, peritoneal dialysis for renal replacement in these patients has been supplanted by haemodialysis and, more recently, haemofiltration. In other parts of the world, however, the procedure, which is relatively simple to do and inexpensive, is still widely used. The objective of these researchers from the Cho Quan Hospital, Ho Chi Minh City, Vietnam, and Radcliffe Hospital and Churchill Hospital, Oxford, England, was to compare acute peritoneal dialysis with haemofiltration. Dr. Nguyen Hoan Phu and colleagues conducted this trial among patients with infection-related acute renal failure in an infectious-disease referral hospital in Vietnam. Participants were 70 adults with severe falciparum malaria (48 patients) or sepsis (22 patients). Thirty-four of these patients were assigned to haemofiltration and 36 to peritoneal dialysis. Mortality rate in the group assigned to peritoneal dialysis was 47 percent (17 patients) versus 15 percent (five patients) among those assigned to haemofiltration (P=0.005). In haemofiltration patients, rates of resolution of acidosis and of decline in the serum creatinine concentrations were more than twice these rates in patients on peritoneal dialysis, and renal replacement therapy was required for a significantly shorter time. Further analysis indicated the odds ratio was 5.1 for death and 4.7 for need for future dialysis in patients assigned to peritoneal dialysis. Per survivor, the cost of haemofiltration was less than half that for peritoneal dialysis, and the cost per life saved was less than one third. These findings indicate use of venovenous haemofiltration is a cost-effective alternative to peritoneal dialysis for treatment of these patients and is also linked with a significantly better clinical outcome.

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