Intermittent hemodialysis not noninferior to continuous renal-replacement therapy

A study published in the New England Journal of Medicine found that intermittent hemodialysis is not noninferior to continuous renal-replacement therapy (CRRT) as an initial treatment for critically ill patients with acute kidney injury (AKI). The research, conducted by Stéphane Gaudry and colleagues, involved 554 patients randomly assigned to receive either intermittent hemodialysis or CRRT.

The trial was stopped early due to a sustained higher mortality signal in the intermittent hemodialysis group compared to the CRRT group. By day 90, the mortality rates were 63.1% for intermittent hemodialysis and 53.5% for CRRT, with a higher adjusted absolute risk difference of 6.28 percentage points. Hypotension was the most common complication related to AKI or renal-replacement therapy, occurring in 68.8% and 66.5% of patients in the intermittent and continuous groups, respectively.

Despite the early stopping of the trial, the authors caution that interpreting the mortality difference requires caution. The study's results indicate that intermittent hemodialysis may not be as effective as CRRT as an initial treatment option for critically ill patients with AKI.