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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Vinsonneau
Christophe
C
Department of Intensive Care, Cochin Port-Royal University Hospital, René Descartes University, Paris, France. christophe.vinsonneau@cch.aphp.fr
Camus
Christophe
C
Combes
Alain
A
Costa de Beauregard
Marie Alyette
MA
Klouche
Kada
K
Boulain
Thierry
T
Pallot
Jean-Louis
JL
Chiche
Jean-Daniel
JD
Taupin
Pierre
P
Landais
Paul
P
Dhainaut
Jean-François
JF
D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*