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2018 ; 3
(2
): 456-463
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Effect of Frequent Dialysis on Renal Recovery: Results From the Acute Renal
Failure Trial Network Study
#MMPMID29725650
Vijayan A
; Delos Santos RB
; Li T
; Goss CW
; Palevsky PM
Kidney Int Rep
2018[Mar]; 3
(2
): 456-463
PMID29725650
show ga
INTRODUCTION: The optimal frequency of intermittent hemodialysis (IHD) in the
treatment of acute kidney injury (AKI) remains unclear. Increasing the frequency
of IHD, while offering the possible advantage of reduced ultrafiltration
requirement and less hemodynamic instability per session, amplifies patient
contact with an extracorporeal circuit with possible deleterious cardiovascular
and immunological consequences. A recent study suggested that intensive renal
replacement therapy (RRT) is associated with a decrease in urine output during
AKI. We hypothesized that increased frequency of IHD may be associated with
delayed renal recovery. METHODS: This is a post hoc analysis of the Acute Renal
Failure Trial Network (ATN) study. The ATN study was a large randomized
multicenter trial of intensive versus less-intensive RRT in critically ill
patients with AKI. This study used either continuous RRT or IHD, depending on the
hemodynamic status of the patient. Of 1124 patients, 246 were treated solely with
IHD during the study period and were included in this analysis. The participants
were randomized to receive IHD 3 days per week (L-IntRRT) or 6 days per week
(IntRRT). The primary outcome of interest was renal recovery at day 28. RESULTS:
L-IntRRT was associated with higher number of RRT-free days through day 28 than
IntRRT (mean difference 2.5 days; 95% confidence interval [CI]: -4.79 to -0.27
days; P = 0.028). The likelihood for renal recovery at day 28 was lower in the
IntRRT group (OR: 0.49; 95% CI: 0.28-0.87; P = 0.016). CONCLUSION: In
hemodynamically stable patients with AKI, intensifying the frequency of IHD from
3 to 6 days per week may be associated with impaired renal recovery.