Intensity of renal support in critically ill patients with acute kidney injury

Paul M. Palevsky, Jane Hongyuan Zhang, Theresa Z. O'Connor, Glenn M. Chertow, Susan T. Crowley, Devasmita Choudhury, Kevin Finkel, John A. Kellum, Emil Paganini, Roland M.H. Schein, Mark W. Smith, Kathleen M. Swanson, B. Taylor Thompson, Anitha Vijayan, Suzanne Watnick, Robert A. Star, Peter Peduzzi, E. Young, R. Fissel, W. Fissel & 192 others U. Patel, K. Belanger, A. Raine, N. Ricci, J. Lohr, P. Arora, D. Cloen, D. Wassel, L. Yohe, J. Amanzadeh, J. Penfield, M. Hussain, R. Katneni, A. Sajgure, A. Swann, G. Dolson, V. Ramanathan, G. Tasby, Robert Bacallao, M. Jaradat, K. Graves, Q. Li, M. Krause, M. Shaver, M. Alam, K. Morris, T. Bland, E. Satter, J. Kraut, A. Felsenfeld, B. Levine, G. Nagami, B. Vaghaiwalla, J. Duffney, J. Moore, C. Cely, E. Jaimes, D. Kett, A. Quartin, M. Arcia, A. Barchi-Chung, V. Batuman, A. Alper, A. Dreisbach, E. Simon, C. Kulivan, N. Aslam, M. Ramkumar, E. Grum, P. Rogers, S. Weisbord, C. Geffel, I. Wahba, D. Kelly, J. Walczyk, G. Feldman, A. Mogyorosi, G. Viol, M. Halverson, S. Schmid, H. Totten, F. Gabbai, S. Mullaney, R. Smith, J. Dingsdale, S. Woods, K. Johansen, D. Lovett, A. O'Hare, J. McCarthy, C. Rosado-Rodriguez, A. Galera, G. Rodriguez-Vega, W. Rodriguez, C. Vilchez, B. Young, D. Andress, A. Lindner, G. Galvin, N. Gourley, A. Peixoto, M. Perkal, C. Joncas, S. Demirjian, J. Yared, R. Brienza, M. Garcia, T. Seifert, L. Sweeney, H. Rabb, M. Atta, R. Brower, M. Choi, J. Eustace, P. Scheel, E. Heck, H. Rahman, J. Niles, H. Bazari, K. Smirnakis, D. Steele, R. Thadhani, K. Laliberte, B. Leeman, C. McCarthy, M. Pescatore, H. Szerlip, P. Fall, M. Jagadeesan, L. Mulloy, W. Paulson, J. White, N. Sickafoose, K. Cho, M. Gropper, K. Liu, M. Matthay, K. Borovitz, M. Koenigsberg, S. Rodriguez, G. Contreras, S. Cohn, J. Diego, D. Kett, A. Quartin, C. Carvalho, D. Carvalho, M. Castro, C. de la Cuesta, I. Espinal, A. Hurtado, P. Oyuela, N. Aslam, M. Unruh, R. Burr, M. Donahoe, J. Marszalek, M. Shields, R. Venkataraman, S. Weisbord, J. Aubrecht, H. Sterling, L. Mandich, A. Shaw, J. Foringer, J. Samuels, B. Efron, M. Rocco, E. Deterding, S. Moossavi, C. Bethea, D. McBride, S. Warren, M. Kollef, K. Sambandam, E. Hammer, M. Hoffman, J. Stokes, A. F. Connors, H. Feldman, J. Greer, G. G. Koch, T. Stewart, J. Wittes, P. Overberger, S. Michler, M. Antonelli, K. Dellert, L. Durant, R. Franchini, A. Kossack, V. McBride, S. O'Neil, T. Roy, J. Russo, J. Vitale, M. Sather, C. Fye, C. M. Haakenson, D. H. Krueger, J. Thornton, C. Dalzell, R. Horney, A. Siroka, P. Su, M. Brophy, D. Humphries, D. Govan, T. J. O'Leary, G. D. Huang, J. R. Feussner, P. Eggers

Research output: Contribution to journalArticle

1035 Citations (Scopus)

Abstract

BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour. RESULTS: Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P = 0.47). There was no significant difference between the two groups in the duration of renal-replacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups. CONCLUSIONS: Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)

Original languageEnglish (US)
Pages (from-to)7-20
Number of pages14
JournalNew England Journal of Medicine
Volume359
Issue number1
DOIs
StatePublished - Jul 3 2008
Externally publishedYes

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Acute Kidney Injury
Critical Illness
Kidney
Renal Replacement Therapy
Renal Dialysis
Hemodiafiltration
Dialysis
Recovery of Function
Hypotension
Therapeutics
Cause of Death
Mortality
Sepsis
Odds Ratio
Body Weight
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Palevsky, P. M., Zhang, J. H., O'Connor, T. Z., Chertow, G. M., Crowley, S. T., Choudhury, D., ... Eggers, P. (2008). Intensity of renal support in critically ill patients with acute kidney injury. New England Journal of Medicine, 359(1), 7-20. https://doi.org/10.1056/NEJMoa0802639

Intensity of renal support in critically ill patients with acute kidney injury. / Palevsky, Paul M.; Zhang, Jane Hongyuan; O'Connor, Theresa Z.; Chertow, Glenn M.; Crowley, Susan T.; Choudhury, Devasmita; Finkel, Kevin; Kellum, John A.; Paganini, Emil; Schein, Roland M.H.; Smith, Mark W.; Swanson, Kathleen M.; Thompson, B. Taylor; Vijayan, Anitha; Watnick, Suzanne; Star, Robert A.; Peduzzi, Peter; Young, E.; Fissel, R.; Fissel, W.; Patel, U.; Belanger, K.; Raine, A.; Ricci, N.; Lohr, J.; Arora, P.; Cloen, D.; Wassel, D.; Yohe, L.; Amanzadeh, J.; Penfield, J.; Hussain, M.; Katneni, R.; Sajgure, A.; Swann, A.; Dolson, G.; Ramanathan, V.; Tasby, G.; Bacallao, Robert; Jaradat, M.; Graves, K.; Li, Q.; Krause, M.; Shaver, M.; Alam, M.; Morris, K.; Bland, T.; Satter, E.; Kraut, J.; Felsenfeld, A.; Levine, B.; Nagami, G.; Vaghaiwalla, B.; Duffney, J.; Moore, J.; Cely, C.; Jaimes, E.; Kett, D.; Quartin, A.; Arcia, M.; Barchi-Chung, A.; Batuman, V.; Alper, A.; Dreisbach, A.; Simon, E.; Kulivan, C.; Aslam, N.; Ramkumar, M.; Grum, E.; Rogers, P.; Weisbord, S.; Geffel, C.; Wahba, I.; Kelly, D.; Walczyk, J.; Feldman, G.; Mogyorosi, A.; Viol, G.; Halverson, M.; Schmid, S.; Totten, H.; Gabbai, F.; Mullaney, S.; Smith, R.; Dingsdale, J.; Woods, S.; Johansen, K.; Lovett, D.; O'Hare, A.; McCarthy, J.; Rosado-Rodriguez, C.; Galera, A.; Rodriguez-Vega, G.; Rodriguez, W.; Vilchez, C.; Young, B.; Andress, D.; Lindner, A.; Galvin, G.; Gourley, N.; Peixoto, A.; Perkal, M.; Joncas, C.; Demirjian, S.; Yared, J.; Brienza, R.; Garcia, M.; Seifert, T.; Sweeney, L.; Rabb, H.; Atta, M.; Brower, R.; Choi, M.; Eustace, J.; Scheel, P.; Heck, E.; Rahman, H.; Niles, J.; Bazari, H.; Smirnakis, K.; Steele, D.; Thadhani, R.; Laliberte, K.; Leeman, B.; McCarthy, C.; Pescatore, M.; Szerlip, H.; Fall, P.; Jagadeesan, M.; Mulloy, L.; Paulson, W.; White, J.; Sickafoose, N.; Cho, K.; Gropper, M.; Liu, K.; Matthay, M.; Borovitz, K.; Koenigsberg, M.; Rodriguez, S.; Contreras, G.; Cohn, S.; Diego, J.; Kett, D.; Quartin, A.; Carvalho, C.; Carvalho, D.; Castro, M.; de la Cuesta, C.; Espinal, I.; Hurtado, A.; Oyuela, P.; Aslam, N.; Unruh, M.; Burr, R.; Donahoe, M.; Marszalek, J.; Shields, M.; Venkataraman, R.; Weisbord, S.; Aubrecht, J.; Sterling, H.; Mandich, L.; Shaw, A.; Foringer, J.; Samuels, J.; Efron, B.; Rocco, M.; Deterding, E.; Moossavi, S.; Bethea, C.; McBride, D.; Warren, S.; Kollef, M.; Sambandam, K.; Hammer, E.; Hoffman, M.; Stokes, J.; Connors, A. F.; Feldman, H.; Greer, J.; Koch, G. G.; Stewart, T.; Wittes, J.; Overberger, P.; Michler, S.; Antonelli, M.; Dellert, K.; Durant, L.; Franchini, R.; Kossack, A.; McBride, V.; O'Neil, S.; Roy, T.; Russo, J.; Vitale, J.; Sather, M.; Fye, C.; Haakenson, C. M.; Krueger, D. H.; Thornton, J.; Dalzell, C.; Horney, R.; Siroka, A.; Su, P.; Brophy, M.; Humphries, D.; Govan, D.; O'Leary, T. J.; Huang, G. D.; Feussner, J. R.; Eggers, P.

In: New England Journal of Medicine, Vol. 359, No. 1, 03.07.2008, p. 7-20.

Research output: Contribution to journalArticle

Palevsky, PM, Zhang, JH, O'Connor, TZ, Chertow, GM, Crowley, ST, Choudhury, D, Finkel, K, Kellum, JA, Paganini, E, Schein, RMH, Smith, MW, Swanson, KM, Thompson, BT, Vijayan, A, Watnick, S, Star, RA, Peduzzi, P, Young, E, Fissel, R, Fissel, W, Patel, U, Belanger, K, Raine, A, Ricci, N, Lohr, J, Arora, P, Cloen, D, Wassel, D, Yohe, L, Amanzadeh, J, Penfield, J, Hussain, M, Katneni, R, Sajgure, A, Swann, A, Dolson, G, Ramanathan, V, Tasby, G, Bacallao, R, Jaradat, M, Graves, K, Li, Q, Krause, M, Shaver, M, Alam, M, Morris, K, Bland, T, Satter, E, Kraut, J, Felsenfeld, A, Levine, B, Nagami, G, Vaghaiwalla, B, Duffney, J, Moore, J, Cely, C, Jaimes, E, Kett, D, Quartin, A, Arcia, M, Barchi-Chung, A, Batuman, V, Alper, A, Dreisbach, A, Simon, E, Kulivan, C, Aslam, N, Ramkumar, M, Grum, E, Rogers, P, Weisbord, S, Geffel, C, Wahba, I, Kelly, D, Walczyk, J, Feldman, G, Mogyorosi, A, Viol, G, Halverson, M, Schmid, S, Totten, H, Gabbai, F, Mullaney, S, Smith, R, Dingsdale, J, Woods, S, Johansen, K, Lovett, D, O'Hare, A, McCarthy, J, Rosado-Rodriguez, C, Galera, A, Rodriguez-Vega, G, Rodriguez, W, Vilchez, C, Young, B, Andress, D, Lindner, A, Galvin, G, Gourley, N, Peixoto, A, Perkal, M, Joncas, C, Demirjian, S, Yared, J, Brienza, R, Garcia, M, Seifert, T, Sweeney, L, Rabb, H, Atta, M, Brower, R, Choi, M, Eustace, J, Scheel, P, Heck, E, Rahman, H, Niles, J, Bazari, H, Smirnakis, K, Steele, D, Thadhani, R, Laliberte, K, Leeman, B, McCarthy, C, Pescatore, M, Szerlip, H, Fall, P, Jagadeesan, M, Mulloy, L, Paulson, W, White, J, Sickafoose, N, Cho, K, Gropper, M, Liu, K, Matthay, M, Borovitz, K, Koenigsberg, M, Rodriguez, S, Contreras, G, Cohn, S, Diego, J, Kett, D, Quartin, A, Carvalho, C, Carvalho, D, Castro, M, de la Cuesta, C, Espinal, I, Hurtado, A, Oyuela, P, Aslam, N, Unruh, M, Burr, R, Donahoe, M, Marszalek, J, Shields, M, Venkataraman, R, Weisbord, S, Aubrecht, J, Sterling, H, Mandich, L, Shaw, A, Foringer, J, Samuels, J, Efron, B, Rocco, M, Deterding, E, Moossavi, S, Bethea, C, McBride, D, Warren, S, Kollef, M, Sambandam, K, Hammer, E, Hoffman, M, Stokes, J, Connors, AF, Feldman, H, Greer, J, Koch, GG, Stewart, T, Wittes, J, Overberger, P, Michler, S, Antonelli, M, Dellert, K, Durant, L, Franchini, R, Kossack, A, McBride, V, O'Neil, S, Roy, T, Russo, J, Vitale, J, Sather, M, Fye, C, Haakenson, CM, Krueger, DH, Thornton, J, Dalzell, C, Horney, R, Siroka, A, Su, P, Brophy, M, Humphries, D, Govan, D, O'Leary, TJ, Huang, GD, Feussner, JR & Eggers, P 2008, 'Intensity of renal support in critically ill patients with acute kidney injury', New England Journal of Medicine, vol. 359, no. 1, pp. 7-20. https://doi.org/10.1056/NEJMoa0802639
Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D et al. Intensity of renal support in critically ill patients with acute kidney injury. New England Journal of Medicine. 2008 Jul 3;359(1):7-20. https://doi.org/10.1056/NEJMoa0802639
Palevsky, Paul M. ; Zhang, Jane Hongyuan ; O'Connor, Theresa Z. ; Chertow, Glenn M. ; Crowley, Susan T. ; Choudhury, Devasmita ; Finkel, Kevin ; Kellum, John A. ; Paganini, Emil ; Schein, Roland M.H. ; Smith, Mark W. ; Swanson, Kathleen M. ; Thompson, B. Taylor ; Vijayan, Anitha ; Watnick, Suzanne ; Star, Robert A. ; Peduzzi, Peter ; Young, E. ; Fissel, R. ; Fissel, W. ; Patel, U. ; Belanger, K. ; Raine, A. ; Ricci, N. ; Lohr, J. ; Arora, P. ; Cloen, D. ; Wassel, D. ; Yohe, L. ; Amanzadeh, J. ; Penfield, J. ; Hussain, M. ; Katneni, R. ; Sajgure, A. ; Swann, A. ; Dolson, G. ; Ramanathan, V. ; Tasby, G. ; Bacallao, Robert ; Jaradat, M. ; Graves, K. ; Li, Q. ; Krause, M. ; Shaver, M. ; Alam, M. ; Morris, K. ; Bland, T. ; Satter, E. ; Kraut, J. ; Felsenfeld, A. ; Levine, B. ; Nagami, G. ; Vaghaiwalla, B. ; Duffney, J. ; Moore, J. ; Cely, C. ; Jaimes, E. ; Kett, D. ; Quartin, A. ; Arcia, M. ; Barchi-Chung, A. ; Batuman, V. ; Alper, A. ; Dreisbach, A. ; Simon, E. ; Kulivan, C. ; Aslam, N. ; Ramkumar, M. ; Grum, E. ; Rogers, P. ; Weisbord, S. ; Geffel, C. ; Wahba, I. ; Kelly, D. ; Walczyk, J. ; Feldman, G. ; Mogyorosi, A. ; Viol, G. ; Halverson, M. ; Schmid, S. ; Totten, H. ; Gabbai, F. ; Mullaney, S. ; Smith, R. ; Dingsdale, J. ; Woods, S. ; Johansen, K. ; Lovett, D. ; O'Hare, A. ; McCarthy, J. ; Rosado-Rodriguez, C. ; Galera, A. ; Rodriguez-Vega, G. ; Rodriguez, W. ; Vilchez, C. ; Young, B. ; Andress, D. ; Lindner, A. ; Galvin, G. ; Gourley, N. ; Peixoto, A. ; Perkal, M. ; Joncas, C. ; Demirjian, S. ; Yared, J. ; Brienza, R. ; Garcia, M. ; Seifert, T. ; Sweeney, L. ; Rabb, H. ; Atta, M. ; Brower, R. ; Choi, M. ; Eustace, J. ; Scheel, P. ; Heck, E. ; Rahman, H. ; Niles, J. ; Bazari, H. ; Smirnakis, K. ; Steele, D. ; Thadhani, R. ; Laliberte, K. ; Leeman, B. ; McCarthy, C. ; Pescatore, M. ; Szerlip, H. ; Fall, P. ; Jagadeesan, M. ; Mulloy, L. ; Paulson, W. ; White, J. ; Sickafoose, N. ; Cho, K. ; Gropper, M. ; Liu, K. ; Matthay, M. ; Borovitz, K. ; Koenigsberg, M. ; Rodriguez, S. ; Contreras, G. ; Cohn, S. ; Diego, J. ; Kett, D. ; Quartin, A. ; Carvalho, C. ; Carvalho, D. ; Castro, M. ; de la Cuesta, C. ; Espinal, I. ; Hurtado, A. ; Oyuela, P. ; Aslam, N. ; Unruh, M. ; Burr, R. ; Donahoe, M. ; Marszalek, J. ; Shields, M. ; Venkataraman, R. ; Weisbord, S. ; Aubrecht, J. ; Sterling, H. ; Mandich, L. ; Shaw, A. ; Foringer, J. ; Samuels, J. ; Efron, B. ; Rocco, M. ; Deterding, E. ; Moossavi, S. ; Bethea, C. ; McBride, D. ; Warren, S. ; Kollef, M. ; Sambandam, K. ; Hammer, E. ; Hoffman, M. ; Stokes, J. ; Connors, A. F. ; Feldman, H. ; Greer, J. ; Koch, G. G. ; Stewart, T. ; Wittes, J. ; Overberger, P. ; Michler, S. ; Antonelli, M. ; Dellert, K. ; Durant, L. ; Franchini, R. ; Kossack, A. ; McBride, V. ; O'Neil, S. ; Roy, T. ; Russo, J. ; Vitale, J. ; Sather, M. ; Fye, C. ; Haakenson, C. M. ; Krueger, D. H. ; Thornton, J. ; Dalzell, C. ; Horney, R. ; Siroka, A. ; Su, P. ; Brophy, M. ; Humphries, D. ; Govan, D. ; O'Leary, T. J. ; Huang, G. D. ; Feussner, J. R. ; Eggers, P. / Intensity of renal support in critically ill patients with acute kidney injury. In: New England Journal of Medicine. 2008 ; Vol. 359, No. 1. pp. 7-20.
@article{b0e04db386fc4e928e8199c53ab9a2ee,
title = "Intensity of renal support in critically ill patients with acute kidney injury",
abstract = "BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour. RESULTS: Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6{\%} with intensive therapy and 51.5{\%} with less-intensive therapy (odds ratio, 1.09; 95{\%} confidence interval, 0.86 to 1.40; P = 0.47). There was no significant difference between the two groups in the duration of renal-replacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups. CONCLUSIONS: Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)",
author = "Palevsky, {Paul M.} and Zhang, {Jane Hongyuan} and O'Connor, {Theresa Z.} and Chertow, {Glenn M.} and Crowley, {Susan T.} and Devasmita Choudhury and Kevin Finkel and Kellum, {John A.} and Emil Paganini and Schein, {Roland M.H.} and Smith, {Mark W.} and Swanson, {Kathleen M.} and Thompson, {B. Taylor} and Anitha Vijayan and Suzanne Watnick and Star, {Robert A.} and Peter Peduzzi and E. Young and R. Fissel and W. Fissel and U. Patel and K. Belanger and A. Raine and N. Ricci and J. Lohr and P. Arora and D. Cloen and D. Wassel and L. Yohe and J. Amanzadeh and J. Penfield and M. Hussain and R. Katneni and A. Sajgure and A. Swann and G. Dolson and V. Ramanathan and G. Tasby and Robert Bacallao and M. Jaradat and K. Graves and Q. Li and M. Krause and M. Shaver and M. Alam and K. Morris and T. Bland and E. Satter and J. Kraut and A. Felsenfeld and B. Levine and G. Nagami and B. Vaghaiwalla and J. Duffney and J. Moore and C. Cely and E. Jaimes and D. Kett and A. Quartin and M. Arcia and A. Barchi-Chung and V. Batuman and A. Alper and A. Dreisbach and E. Simon and C. Kulivan and N. Aslam and M. Ramkumar and E. Grum and P. Rogers and S. Weisbord and C. Geffel and I. Wahba and D. Kelly and J. Walczyk and G. Feldman and A. Mogyorosi and G. Viol and M. Halverson and S. Schmid and H. Totten and F. Gabbai and S. Mullaney and R. Smith and J. Dingsdale and S. Woods and K. Johansen and D. Lovett and A. O'Hare and J. McCarthy and C. Rosado-Rodriguez and A. Galera and G. Rodriguez-Vega and W. Rodriguez and C. Vilchez and B. Young and D. Andress and A. Lindner and G. Galvin and N. Gourley and A. Peixoto and M. Perkal and C. Joncas and S. Demirjian and J. Yared and R. Brienza and M. Garcia and T. Seifert and L. Sweeney and H. Rabb and M. Atta and R. Brower and M. Choi and J. Eustace and P. Scheel and E. Heck and H. Rahman and J. Niles and H. Bazari and K. Smirnakis and D. Steele and R. Thadhani and K. Laliberte and B. Leeman and C. McCarthy and M. Pescatore and H. Szerlip and P. Fall and M. Jagadeesan and L. Mulloy and W. Paulson and J. White and N. Sickafoose and K. Cho and M. Gropper and K. Liu and M. Matthay and K. Borovitz and M. Koenigsberg and S. Rodriguez and G. Contreras and S. Cohn and J. Diego and D. Kett and A. Quartin and C. Carvalho and D. Carvalho and M. Castro and {de la Cuesta}, C. and I. Espinal and A. Hurtado and P. Oyuela and N. Aslam and M. Unruh and R. Burr and M. Donahoe and J. Marszalek and M. Shields and R. Venkataraman and S. Weisbord and J. Aubrecht and H. Sterling and L. Mandich and A. Shaw and J. Foringer and J. Samuels and B. Efron and M. Rocco and E. Deterding and S. Moossavi and C. Bethea and D. McBride and S. Warren and M. Kollef and K. Sambandam and E. Hammer and M. Hoffman and J. Stokes and Connors, {A. F.} and H. Feldman and J. Greer and Koch, {G. G.} and T. Stewart and J. Wittes and P. Overberger and S. Michler and M. Antonelli and K. Dellert and L. Durant and R. Franchini and A. Kossack and V. McBride and S. O'Neil and T. Roy and J. Russo and J. Vitale and M. Sather and C. Fye and Haakenson, {C. M.} and Krueger, {D. H.} and J. Thornton and C. Dalzell and R. Horney and A. Siroka and P. Su and M. Brophy and D. Humphries and D. Govan and O'Leary, {T. J.} and Huang, {G. D.} and Feussner, {J. R.} and P. Eggers",
year = "2008",
month = "7",
day = "3",
doi = "10.1056/NEJMoa0802639",
language = "English (US)",
volume = "359",
pages = "7--20",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "1",

}

TY - JOUR

T1 - Intensity of renal support in critically ill patients with acute kidney injury

AU - Palevsky, Paul M.

AU - Zhang, Jane Hongyuan

AU - O'Connor, Theresa Z.

AU - Chertow, Glenn M.

AU - Crowley, Susan T.

AU - Choudhury, Devasmita

AU - Finkel, Kevin

AU - Kellum, John A.

AU - Paganini, Emil

AU - Schein, Roland M.H.

AU - Smith, Mark W.

AU - Swanson, Kathleen M.

AU - Thompson, B. Taylor

AU - Vijayan, Anitha

AU - Watnick, Suzanne

AU - Star, Robert A.

AU - Peduzzi, Peter

AU - Young, E.

AU - Fissel, R.

AU - Fissel, W.

AU - Patel, U.

AU - Belanger, K.

AU - Raine, A.

AU - Ricci, N.

AU - Lohr, J.

AU - Arora, P.

AU - Cloen, D.

AU - Wassel, D.

AU - Yohe, L.

AU - Amanzadeh, J.

AU - Penfield, J.

AU - Hussain, M.

AU - Katneni, R.

AU - Sajgure, A.

AU - Swann, A.

AU - Dolson, G.

AU - Ramanathan, V.

AU - Tasby, G.

AU - Bacallao, Robert

AU - Jaradat, M.

AU - Graves, K.

AU - Li, Q.

AU - Krause, M.

AU - Shaver, M.

AU - Alam, M.

AU - Morris, K.

AU - Bland, T.

AU - Satter, E.

AU - Kraut, J.

AU - Felsenfeld, A.

AU - Levine, B.

AU - Nagami, G.

AU - Vaghaiwalla, B.

AU - Duffney, J.

AU - Moore, J.

AU - Cely, C.

AU - Jaimes, E.

AU - Kett, D.

AU - Quartin, A.

AU - Arcia, M.

AU - Barchi-Chung, A.

AU - Batuman, V.

AU - Alper, A.

AU - Dreisbach, A.

AU - Simon, E.

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PY - 2008/7/3

Y1 - 2008/7/3

N2 - BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour. RESULTS: Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P = 0.47). There was no significant difference between the two groups in the duration of renal-replacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups. CONCLUSIONS: Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)

AB - BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour. RESULTS: Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P = 0.47). There was no significant difference between the two groups in the duration of renal-replacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups. CONCLUSIONS: Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)

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U2 - 10.1056/NEJMoa0802639

DO - 10.1056/NEJMoa0802639

M3 - Article

VL - 359

SP - 7

EP - 20

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 1

ER -