Abstract
Background
Acute kidney injury (AKI) requiring dialysis in critically ill patients is associated with an in-hospital mortality rate of 50–80 %. Extended daily hemodialysis (EHD) and high volume peritoneal dialysis (HVPD) have emerged as alternative modalities.
Methods
A double-center, randomized, controlled trial was conducted comparing EHD versus HVPD for the treatment for AKI in the intensive care unit (ICU). Four hundred and seven patients were randomized and 143 patients were analyzed. Principal outcome measure was hospital mortality, and secondary end points were recovery of renal function and metabolic and fluid control.
Results
There was no difference between the two groups in relation to median ICU stay [11 (5.7–20) vs. 9 (5.7–19)], recovery of kidney function (26.9 vs. 29.6 %, p = 0.11), need for chronic dialysis (9.7 vs. 6.5 %, p = 0.23), and hospital mortality (63.4 vs. 63.9 %, p = 0.94). The groups were different in metabolic and fluid control. Blood urea nitrogen (BUN), creatinine, and bicarbonate levels were stabilized faster in EHD group than in HVPD group. Delivered Kt/V and ultrafiltration were higher in EHD group. Despite randomization, there were significant differences between the groups in some covariates, including age, pre-dialysis BUN, and creatinine levels, biased in favor of the EHD. Using logistic regression to adjust for the imbalances in group assignment, the odds of death associated with HVPD was 1.4 (95 % CI 0.7–2.4, p = 0.19). A detailed investigation of the randomization process failed to explain the marked differences in patient assignment.
Conclusions
Despite faster metabolic control and higher dialysis dose and ultrafiltration with EHD, this study provides no evidence of a survival benefit of EHD compared with HVPD. The limitations of this study were that the results were not presented according to the intention to treat and it did not control other supportive management strategies as nutrition support and timing of dialysis initiation that might influence outcomes in AKI.
Similar content being viewed by others
References
Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–881
Ricci Z, Ronco C, D’amico G et al (2006) Practice patterns in the management of acute renal failure in the critically Ill patient: an international survey. Nephrol Dial Transplant 21(3):690–696
Ikizler TA, Himmelfarb J (2007) Acute kidney injury: changing lexicography, definitions, and epidemiology. Kidney Int 71:971–976
Mehta RL et al (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60:1154–1163
Himmelfarb J (2007) Continuous dialysis is not superior to intermittent dialysis in acute kidney injury of critically ill patient. Nat Clin Pract Nephrol 3:120–121
Gabriel DP, Nascimento GVR, Caramori JT, Martim LC, Barretti P, Balbi AL (2006) Peritoneal dialysis in acute acute renal failure. Ren Fail 28(6):451–456
Uehlinger DE et al (2005) Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant 20:1630–1637
Augustine JJ et al (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44:1000–1007
Vinsonneau C et al (2006) Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicenter randomized trial. Lancet 368:379–385
Marshall MR, Ma T, Galler D, Rankin APN, Williams AB (2004) Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards and adequate therapy. Nephrol Dial Transplant 19(4):877–884
Kumar VA, Craig M, Depner TA, Yeun JY (2000) A new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 36(2):294–300
Gabriel DP, Nascimento GVR, Caramori JT, Martim LC, Barretti P, Balbi AL (2007) High volume peritoneal diálisis for acute renal failure. Perit Dial Int 27:277–282
Ponce D, Balbi A (2011) Peritoneal dialysis in acute kidney injury: a viable alternative. Perit Dial Int 31(4):387–389
Gabriel DP, Caramori JT, Martim LC, Barretti P, Balbi AL (2008) Continuous peritoneal dialysis × daily hemodialysis in acute kidney injury: a prospective and randomized trial. Kidney Int 73:S87–S93
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31
Liano F, Gallego A, Pascual J, Garcia-Martin F, Teruel JL, Marcen R et al (1993) Prognosis of acute tubular necrosis: an extended prospectively contrasted study. Nephron 63:21–23
Du Bois D, Du Bois EF (1915) The measurement of surface area of man. Arch Int Med 15:868–881
Chumlea WC, Roche AF, Steinbaugh ML (1985) Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatric Soc 33:116–120
Watson PE, Watson ID, Batt RD (1980) Total body water volumes for adults males and females estimated from simple anthropometric measurements. Am J Clin Nutr 33:27–39
Daugirdas JT (2007) Physiologic principles and urea kinetic modeling. In: Daugirdas JT, Blake PG, Ing TS (eds) Handbook of dialysis, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 23–53
Manns M, Sigler MH, Teehan BP (1997) Intradialytic renal haemodynamics: potential consequences for the management of the patient with acute renal failure. Nephrol Dial Transplant 12:870–872
Ronco C (2007) Can peritoneal dialysis be considered an option for the treatment of acute kidney injury? Perit Dial Int 27:251–253
Passadakis PS, Oreopoulos GD (2007) Peritoneal dialysis in patients with acute renal failure. Adv Perit Dial 23:7–16
Ronco C (2006) Factors affecting hemodialysis and peritoneal dialysis efficiency. Contrib Nephrol 150:1–12
Chionh CY, Soni S, Cruz DN, Ronco C (2009) Peritoneal dialysis for acute kidney injury: techniques and dose. Contrib Nephrol 163:278–284
Phu NH, Hien TT, Mai NTH, Chau TT, Chuong LV, Loc PP et al (2002) Hemofiltration and peritoneal dialysis in infection associated acute renal failure in Vietnam. N Engl J Med 347:895–902
George G, Varma S, Kumar S, Thomas J, Gopi S, Pisharodi R (2011) Comparing continuous vevovenous hemodiafiltration and peritoneal dialysis in critical ill patients with acute kidney injury: a pilot study. Perit Dial Int 4:422–429
Bazari H (2003) Hemofiltration and peritoneal dialysis in infection-associated acute renal failure. N Engl J Med 27:858–860
Burdmann EA, Chakravarthi R (2011) Peritoneal dialysis in acute kidney injury: lessons learned and applied. Semin Dial 24(2):149–156
Almeida Puatto C, Ponce D, Balbi AL (2001) Avaliacao da Mecanica Ventilatoria de Pacientes com Lesao Renal Aguda submetidos a Dialise Peritoneal Continua ou a Hemodialise Diaria. In: Presented at the Anais do XVI Congresso Paulista de Nefrologia, Atibaia, Sao Paulo, Brazil, 16–19 Sept 2001
VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA,Peduzzi P (2008) Intensity of renal support in critically Ill patients with acute kidney injury. N Engl J Med 10:359–373
RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S (2009) Intensity of continuous renal-replacement therapy in critically Ill patients. N Engl J Med 17:1627–1638
Chitalia V, Almeida AF, Rai H, Bapat M, Vipul KC, Khannal R (2002) Is peritoneal dialysis adequate for hypercatabolic acute renal failure in developing countries? Kidney Int 61:747–757
Vijayan A, Palevsky PM (2012) Dosage of renal replacement therapy in acute kidney injury. Am J Kidney Dis 4:569–576
Ponce D, Brito GA, Abrão JMG, Balbi AL (2011) Different peritoneal dialysis doses and outcome of acute kidney injury patients. Adv Perit Dial 27:118–124
Chionh CY, Ronco C, Finkelstein FO, Soni SS, Cruz DN (2010) Acute peritoneal dialysis: what is the ‘adequate’ dose for acute kidney injury? Nephrol Dial Transplant 25:3155–3160
Ponce D, Berbel MN, Almeida CTP, Goes CR, Balbi AL (2012) High volume peritoneal dialysis in acute kidney injury: indications and limitations. Clin J Am Soc Nephrol 7:887–889
Acknowledgment
This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ponce, D., Berbel, M.N., Abrão, J.M.G. et al. A randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients. Int Urol Nephrol 45, 869–878 (2013). https://doi.org/10.1007/s11255-012-0301-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-012-0301-2