RecentRCT

ICRAKI

Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury

New England Journal of Medicine, 2026 · Multicenter randomized noninferiority trial, stopped early; 535 patients in the intention-to-treat analysis

Population: Critically ill adults with severe AKI and an indication for renal replacement therapy
Intervention: Initial intermittent hemodialysis
Comparator: Initial continuous renal replacement therapy
Primary outcome: Major adverse kidney events at 90 days
Result: Major adverse kidney events occurred in 78.1% versus 71.6%; intermittent therapy did not establish noninferiority. Day-90 death occurred in 63.1% versus 53.5% (mortality hazard ratio 1.30, 95% CI 1.04–1.63).

What the trial found

Major adverse kidney events occurred in 78.1% versus 71.6%; intermittent therapy did not establish noninferiority. Day-90 death occurred in 63.1% versus 53.5% (mortality hazard ratio 1.30, 95% CI 1.04–1.63).

Current guideline position

This trial must be interpreted alongside indication-specific guidance; its result alone does not establish a universal treatment policy.

Clinical interpretation

The mortality signal favors continuous initial therapy in this population. Reassess blanket modality-equivalence claims, while recognizing early stopping and context; this does not prove that CRRT is superior for every ICU patient.

Limitations

Early termination limits precision and can exaggerate effect estimates.
Initial modality is distinct from initiation timing, dialysis intensity and later modality transitions.

Clinical Context & Relevant Topics (2)

Disease Reference

Acute Kidney Injury in Critical Care

Sepsis-AKI microcirculatory decoupling, KDIGO staging, Furosemide Stress Test (FST), urine microscopy, and the AEIOU dialysis threshold framework.

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Continuous Renal Replacement Therapy (CRRT)

Principles of convection vs diffusion, filtration fraction, delivered effluent dosing (20–25 mL/kg/h), Regional Citrate Anticoagulation, and citrate toxicity.

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