Acute renal failure: no clear role for intensive dialysis.

Clinical bottom line (level 2b-)

  1. In patients with acute renal failure intensive dialysis was not clearly better than a normal regimen in preventing short term mortality.
Gillum et al: Clinical Nephrology 1986; 25 (5): 249-255
Expires April 2003

The study

Unblinded concealed quasi-randomised trial without intention-to-treat
Setting: renal and electrolyte services of two university hospitals, USA

34 patients (aged mean 57, 85% male) acute renal failure (azotaemia, UNa>50 mmol/l, Uosm<400 mOsm/kg, U/Pcr<20)

Excluded if
  • aged <20 years


    • Control Group: (n = 17, 17 analysed): non-intensive dialysis- predialysis<100, creatinine <9 mg/dl (usually dialysis of 5-6 hours every 1-3 days)
    Experimental Group: (n = 17, 17 analysed): intensive dialysis- to maintain predialysis urea <60, creatinine<5 mg/dl (usually daily dialysis of 5-6 hours)

    100% followed for 4 weeks

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    death 4 weeks 8
    (47.1%)    		 10
    (58.8%)    		 -25%
    (-138% to 34%)    		 -11.8%
    (-45.1% to 21.6%)    		 9
    (NNT = 2 to infinity;
    NNH = 5 to infinity)

    Comments

    1. Patients started dialysis five days in the intensive group and after seven days in the non-intensive group. The groups were not well matched for underlying disease, acuity or severity of illness.
    2. There was no clear difference in the complication rate between the two groups.
    3. The study is too small to exclude potential benefit from using an intensive dialysis regimen.
    4. The nature of the dialytic intervention: bioincompatible membranes and haemodynamically stressful blood flows may have negated any benefits in the intensive group.

    Citation

    1. Gillum DM, Dixon BS, Yanover MJ: The role of intensive dialysis in acute renal failure. Clinical Nephrology 1986; 25 (5): 249-255
    Contributor: Chris Ball and Clare Wotton, April 2000
    Reviewer: Harold Szerlip

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure intensive dialysis
    Comparison non-intensive dialysis
    Outcome death