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Intermittent hemodialysis as an initial treatment approach is not noninferior to continuous renal-replacement therapy (CRRT) among critically ill patients with acute kidney injury (AKI) with indications for renal replacement therapy, according to a study published online Oct. 14 in the New England Journal of Medicine.

Stéphane Gaudry, M.D., Ph.D., from Assistance Publique-Hôpitaux de Paris in France, and colleagues conducted a multicenter, open-label, noninferiority trial involving critically ill adults with AKI who had indications for renal-replacement therapy. Participants were randomly assigned to undergo initial treatment with intermittent hemodialysis or CRRT (272 and 282 patients, respectively).

After sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with CRRT, the trial was stopped early. The researchers found that a major adverse kidney event occurred by day 90 in 78.1% and 71.6% of patients in the intermittent and continuous groups (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval, −1.22 to 13.79).

Death by day 90 occurred in 63.1% and 53.5% of patients in the intermittent and continuous groups, respectively. At day 90, Kaplan-Meier mortality estimates were 63.3% and 53.6% (hazard ratio, 1.30). Hypotension was the most common complication potentially related to AKI or renal-replacement therapy, which occurred in 68.8% and 66.5% of patients in the intermittent and continuous groups, respectively.

"Because the trial was stopped early, the magnitude of the mortality difference should be interpreted with caution," the authors write.

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