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Daily hemodialysis and the outcome of acute renal failure.
- Source :
-
The New England journal of medicine [N Engl J Med] 2002 Jan 31; Vol. 346 (5), pp. 305-10. - Publication Year :
- 2002
-
Abstract
- Background: Intermittent hemodialysis is widely used as renal-replacement therapy in patients with acute renal failure, but an adequate dose has not been defined. We performed a prospective study to determine the effect of daily intermittent hemodialysis, as compared with conventional (alternate-day) intermittent hemodialysis, on survival among patients with acute renal failure.<br />Methods: A total of 160 patients with acute renal failure were assigned to receive daily or conventional intermittent hemodialysis. Survival was the primary end point of the study. The duration of acute renal failure and the frequency of therapy-related complications were secondary end points.<br />Results: The two study groups were similar with respect to age, sex, cause and severity of acute renal failure, medical or surgical intensive care setting, and the score on the Acute Physiology, Age, and Chronic Health Evaluation. Daily hemodialysis resulted in better control of uremia, fewer hypotensive episodes during hemodialysis, and more rapid resolution of acute renal failure (mean [+/-SD], 9+/-2 vs. 16+/-6 days; P=0.001) than did conventional hemodialysis. The mortality rate, according to the intention-to-treat analysis, was 28 percent for daily dialysis and 46 percent for alternate-day dialysis (P=0.01). In a multiple regression analysis, less frequent hemodialysis (on alternate days, as opposed to daily) was an independent risk factor for death.<br />Conclusions: The high mortality rate among critically ill patients with acute renal failure who require renal-replacement therapy is related to both coexisting conditions and uremic damage to other organ systems. Intensive hemodialysis reduces mortality without increasing hemodynamically induced morbidity.
- Subjects :
- APACHE
Acute Kidney Injury classification
Acute Kidney Injury complications
Acute Kidney Injury mortality
Critical Illness
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Oliguria etiology
Prospective Studies
Sepsis complications
Treatment Outcome
Acute Kidney Injury therapy
Renal Dialysis
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 346
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 11821506
- Full Text :
- https://doi.org/10.1056/NEJMoa010877