RCT

ATN

Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

NEJM, 2008 · Multicenter randomized trial in 27 VA and university medical centers (n=1124)

Clinical question

Does intensive renal replacement therapy reduce mortality in critically ill AKI patients compared with standard therapy?

Population: ICU patients with AKI and failure of at least one non-renal organ or sepsis
Intervention: Intensive renal support (CVVHDF at 35 mL/kg/h or daily intermittent hemodialysis)
Comparator: Standard renal support (CVVHDF at 20 mL/kg/h or intermittent hemodialysis 3x/week)
Primary outcome: All-cause mortality at 60 days
Result: 60-day mortality was 53.6% in the intensive-strategy group vs 51.5% in the less-intensive group (odds ratio 1.09, 95% CI 0.86 to 1.40, P=0.47). Recovery of kidney function was similar (15.4% vs 16.5%, P=0.75).

What the trial found

Intensive dialysis dose or frequency does not improve survival, renal recovery, or reduce organ failure in ICU AKI.

Current guideline position

KDIGO 2012 guidelines recommend delivering an effluent volume of 20–25 mL/kg/h for CRRT (Level 1A recommendation).

Clinical interpretation

Reaffirmed the standard target effluent dose of 20-25 mL/kg/h for continuous RRT.

Clinical Context & Relevant Topics (2)

Disease Reference

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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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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