Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury
Primary result · Major adverse kidney event (death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value)Result — go to the resultAdjusted absolute risk difference 6.28 percentage points 95% CI −1.22 to 13.79Authors' conclusion
Among critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.).
Study context
- Population
- Critically ill adults with acute kidney injury who had indications for renal-replacement therapyunderwent randomization, 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population
- Participants
- 554 adults
- Comparison
- Intermittent hemodialysis vs Continuous renal-replacement therapy
- Intermittent hemodialysisn = 272
- Continuous renal-replacement therapyn = 282reference
- Primary endpoint
- Major adverse kidney event:
- Death
- Dependence on renal-replacement therapy
- A serum creatinine concentration more than 25% above the baseline value
- Follow-up
- By day 90
Methodological detailsrandomly assigned, intention-to-treat population
- Randomly assigned
- Intention-to-treat population
Primary result
As reported in the abstract
Adjusted absolute risk difference
6.28 percentage points
95% CI −1.22 to 13.79
Events by treatment group
Further findings
| Outcome | Intermittent hemodialysis | Continuous renal-replacement therapy | Hazard ratio (95% CI) | |
|---|---|---|---|---|
| Death · by day 90 | 63.1% | 53.5% | 1.30 (1.04–1.63) | |
| Kaplan-Meier mortality estimate at day 90 | 63.3% | 53.6% | ||
| 0.512Hazard ratio (log scale) |
Early stopping
- The trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy
Safety
Hypotension (most common complication potentially related to acute kidney injury or renal-replacement therapy)
Original publication
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