Alternative net ultrafiltration rate strategies in acute kidney injury: a feasibility randomized clinical trial
Authors' conclusion
In conclusion, despite high protocol adherence, there was minimal separation in delivered UFNET rates.
Study context
- Population
- Patients with acute kidney injury on continuous kidney replacement therapy (CKRT) in 10 ICUs across 2 healthcare systems, July 2022 to June 2024
- Participants
- 97 patients · 10 ICUs
- Comparison
- Restrictive vs liberal net ultrafiltration rate strategy during CKRT
- Restrictiven = 42
- Liberaln = 55reference
- Primary endpoint
- Coprimary: between-group separation in UFNET rates, protocol adherence, and recruitment rate
Methodological detailsstepped-wedge cluster-randomized, multicentre, Each ICU a cluster; 1 ICU randomly transitioned from liberal to restrictive every two months after the first six months
- Stepped-wedge cluster-randomized
- Multicentre
- Each ICU a cluster; 1 ICU randomly transitioned from liberal to restrictive every two months after the first six months
Primary result
As reported in the abstract
Delivered UFNET rate (separation)
P = 0.4
Further findings
Delivered UFNET rate, per-protocol analysis
- Significant between-group separation in mean UFNET rates, liberal vs restrictive (mean [SD], mL/kg/h)
- 2.24 [0.72] vs. 1.22 [0.32]
- Per-protocol analysis
- P = 0.002
Protocol deviations (coprimary: protocol adherence)
- Protocol deviations similar, liberal vs restrictive
- 9.1% vs.7.1%
- P = 0.7
Recruitment rate (coprimary)
- Recruitment rate, mean (SD) patients per ICU per two months
- 0.99 (0.27)
Use of rescue UFNET
- Use of rescue UFNET higher in the restrictive group
- 14.5% vs. 66.7%
- P < 0.001
Original publication
Alternative net ultrafiltration rate strategies in acute kidney injury: a feasibility randomized clinical trial. Crit Care. Published 22 April 2026. doi:10.
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