Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in multiple-organ dysfunction
Hemodiafe trial design and results
Design
Multicentre randomised controlled trial
Treatment
Continuous venovenous haemodiafiltration
Control
Intermittent haemodialysis
Population
360 patients with acute renal failure as part of multiple-organ dysfunction syndrome
Follow-up
60 days
Primary endpoint
60-day survival
Result
60-day survival was 32% with intermittent haemodialysis and 33% with continuous renal replacement therapy (95% CI for the difference -8.8 to 11.1), with no difference at any other timepoint.
These data suggest that, provided strict guidelines to improve tolerance and metabolic control are used, almost all patients with acute renal failure as part of multiple-organ dysfunction syndrome can be treated with intermittent haemodialysis.
The trial authors, in the published abstract
How it has aged
The conditional in the authors' conclusion is the whole finding: intermittent dialysis works in shocked patients provided strict protocols manage the haemodynamic tolerance. Continuous therapy persists largely because those protocols are demanding, not because the modality is superior.
Publications
Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial
Vinsonneau C, Camus C, Combes A, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 2006 Jul 29;368(9533):379-85.
60-day survival 32% versus 33%
No difference at any timepoint
Required strict protocols for tolerance and metabolic control