Abstract
The optimal dialysis dose for acute kidney injury is a matter of great controversy. Clinical trials, predominantly single-center studies, have shown conflicting results. The Acute Renal Failure Trial Network (ATN) Study was designed to compare clinical outcomes between patients allocated to an intensive dose versus a less-intensive dose of renal replacement therapy. Recently, the results of this large randomized controlled multicenter study were published. The present article will discuss certain aspects of this trial: the overall design, the baseline patient characteristics, and comparison of the results with earlier studies. Finally, the article will address the implications of the ATN Study results for clinical practice.
Highlights
Since the original formulation of the dose concept for renal replacement therapy more than 30 years ago [1] and the establishment of a link between dose and clinical outcome [2,3], individualized patient dosing based on urea clearance is routine in end-stage renal disease (ESRD) patients
A second randomized controlled trial (RCT) demonstrated higher survival and renal recovery rate in acute kidney injury (AKI) patients receiving an average of six intermittent hemodialysis (IHD) treatments per week compared with patients treated an average three times per week [5]
This low utilization of sustained low efficiency dialysis (SLED) in hemodynamically unstable patients occurred despite the investigators’ ability to prescribe either SLED or continuous renal replacement therapy (CRRT) in the study. These findings corroborate large observational trials [15,16,17] that demonstrate CRRT is the standard of care for hemodynamically unstable patients with AKI. These results suggest clinicians do not yet believe SLED is clinically equivalent to CRRT for the most critically ill patients, and the results suggest that the probable use of SLED in this patient population has been overestimated, based on information appearing in the literature and provided at congresses
Summary
Since the original formulation of the dose concept for renal replacement therapy more than 30 years ago [1] and the establishment of a link between dose and clinical outcome [2,3], individualized patient dosing based on urea clearance is routine in end-stage renal disease (ESRD) patients. The frequency at which severe hypotension occurred in the IHD-treated patients was 2.5-fold greater than the same frequency in patients treated with CRRT – even though the latter group was more critically ill, more hemodynamically unstable, and required much higher net ultrafiltration volumes for fluid balance These hemodynamic data are important in light of the continuing belief by many experts that any episode of hypotension in an AKI patient, even if very transient, can cause further kidney injury and possibly reduce the likelihood of renal recovery. The dose did not have a significant impact on renal recovery, it is not clear from the reported data whether the dialysis modality played a role This is a relevant question because recent large observational trials suggest that the use of CRRT results in a higher rate of renal recovery after AKI than the use of IHD [16,17]. Dialysis Study [25]: these years led to increased morbidity and mortality due to unscheduled underdialysis [26]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
