RCT

RENAL

Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

NEJM, 2009 · Multicenter randomized trial in 35 ICUs across Australia and New Zealand (n=1508)

Clinical question

Does high-intensity continuous renal replacement therapy improve 90-day survival compared with standard-intensity therapy in critically ill AKI?

Population: Critically ill adult ICU patients with severe acute kidney injury requiring continuous RRT
Intervention: Higher-intensity CRRT (effluent flow rate of 40 mL/kg/hour)
Comparator: Lower-intensity CRRT (effluent flow rate of 25 mL/kg/hour)
Primary outcome: All-cause mortality at 90 days
Result: 90-day mortality was identical between the higher-intensity (44.7%) and lower-intensity (44.7%) groups (odds ratio 1.00, 95% CI 0.81 to 1.23, P=0.99). Dialysis dependence at 90 days was also identical (6.8% vs 4.4%, P=0.14).

What the trial found

Increasing CRRT dose from 25 to 40 mL/kg/h provides no benefit in survival or renal recovery.

Current guideline position

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

Clinical interpretation

Established a delivered CRRT effluent dose of 20-25 mL/kg/h as the global standard of care, avoiding unnecessary filter clogging and nutrient loss.

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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