Archive for the ‘Renal’ Tag

Renal Intensity – How High ?

The ANZICS group appear to have done it again; that is taken a single centre trial done in Europe, repeated it in a sensible and pragmatic way but in a much larger, adequately powered multi centre setting and determined an evidence based outcome. It’s something of a shame that again the evidence based outcome doesn’t support the optimism of the initial trial.
This time the therapy in question is the ‘dose’ of RRT (renal replacement therapy). A previous trial by influential group led by Ronco suggested a survival benefit of 35mls/kg/hr effluent flow rate as opposed to 20ml/kg/hr. A major US study (the Veterans/NIH study) showed no difference in mortality but was limited in its application is the UK because of the relatively large proportion of patients who received intermittent heamodialysis, and the slightly complicated rationale for choosing which patients received which therapy. Most UK ICUs would provide only CVVH (or variants) to ICU patients.
Intensity of Renal Replacement Therapy in Critically Ill Patients. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S.   N Engl J Med.   2009 Oct 22;361(17):1627-3.

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Intensity of Renal Support. NIH ARF Trial Network. NEJM 2008.

Intensity of Renal Support in Critically Ill patients with Acute Kidney Injury. VA/NIH Acute Renal Failure Trial Network. N Engl J Med: May 20, 2008;359.

A copy of this paper is available as a PDF in the file box, or you can click the link above for full text.

Intro : This multicentre, non blinded RCT had 2 arms; High intensity intermittent HD (6/week) or CVVH at 35ml/kg vs low intensity intermittant HD (3/week) or CVVH at 20ml/kg. HD was used if the patient’s were heamodynamically stable (defined by cardiovascular SOFA score <2). 1124 patient’s randomised if ARF + 1 additional organ failure present (CRF excluded). Patients on low intensity treatment were permitted isolated ultra-filtration for volume overload if required . Primary end point was all cause mortality at 60 days.

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