title: The effect of continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure (CONVINT): a prospective randomized controlled trial.
abstract: BACKGROUND
  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 investigated 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 intrahospital mortality, as well as course of disease severity/biomarkers and need for organ-support therapy.
  
  
  RESULTS
  At baseline, no differences in disease severity, distributions of age and gender, or suspected reasons for 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 intrahospital 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-/intrahospital 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.
  
  
  BACKGROUND
  NCT01228123, clinicaltrials.gov.
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Rene
authors.initials: R
authors.lastname: Pschowski
authors.forename: Thorsten
authors.initials: T
authors.lastname: Bender
authors.forename: Cathrin
authors.initials: C
authors.lastname: Berkmann
authors.forename: Sophie
authors.initials: S
authors.lastname: Briegel
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hasper
authors.forename: Achim
authors.initials: A
authors.lastname: Jörres
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D006440:Hemofiltration / Q000401:mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality / Q000639:trends*; D017582:Renal Replacement Therapy / Q000401:mortality / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome