A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury: The Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial
Authors' conclusion
A conservative dialysis strategy in dialysis-requiring acute kidney injury resulted in a shorter time to and higher rates of recovery of kidney function in the unadjusted analysis.
Study context
- Population
- Hemodynamically stable patients with dialysis-requiring AKI, baseline eGFR >15 mL/min/1.73 m², already on kidney replacement therapy, planned intermittent hemodialysis; 4 US sites220 received allocated intervention
- Participants
- 221 patients
- Comparison
- Conservative vs conventional dialysis strategy
- Conservative dialysisn = 109
- Conventional dialysisn = 109reference
- Primary endpoint
- Unadjusted kidney function recovery (alive, not receiving dialysis, with ≥14 consecutive days without dialysis, including after discharge)
- Follow-up
- Hospital discharge
Methodological detailsmulticentre, unblinded, superiority
- Multicentre
- Unblinded
- Superiority
Primary result
As reported in the abstract
Conservative dialysis vs Conventional dialysisDifference (95% CI)P value
Conservative dialysis
13.8%(0.8%–26.8%)
P = 0.04Conservative dialysis vs Conventional dialysisEstimate (95% CI)P value
Conservative dialysis
unadjusted OR 1.76(1.02–3.03)
P = 0.04After prespecified adjustment
OR 1.56(0.86–2.84)
P = 0.15Secondary outcomes
Median
| Outcome | Conservative dialysis | Conventional dialysis | Difference (95% CI) | |
|---|---|---|---|---|
| Dialysis sessions per week (key secondary) | 1.8 (IQR 0–2.6) | 3.1 (IQR 2.6–3.5) | −1.4 (−1.8 to −1.0) | |
| −2−101Difference (linear scale) |
Days
| Outcome | Conservative dialysis | Conventional dialysis | Difference (days) (95% CI) | |
|---|---|---|---|---|
| Consecutive dialysis-free days to day 28 (key secondary) | 21 (IQR 0–28) | 5 (IQR 0–21) | 16 (5–27) | |
| −2002040Difference, days (linear scale) |
Safety
Events
| Outcome | Conservative dialysis | Conventional dialysis |
|---|---|---|
| Dialysis-associated hypotension (events) | 69 | 97 |
Original publication
A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury: The Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial. JAMA. Published 27 January 2026. doi:10.
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