Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury

BACKGROUND: The preferred method of renal-replacement therapy for acute kidney injury in critically ill patients remains uncertain. METHODS: In this multicenter, open-label, noninferiority trial, we randomly assigned critically ill adults with acute kidney injury who had indications for renal-replacement therapy to undergo intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. The primary outcome was a major adverse kidney event - defined as death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value - by day 90. RESULTS: The trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy. A total of 554 patients underwent randomization, with 272 patients assigned to undergo intermittent hemodialysis and 282 to undergo continuous renal-replacement therapy; 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population. A major adverse kidney event occurred by day 90 in 203 patients (78.1%) in the intermittent group and in 197 patients (71.6%) in the continuous group (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval [CI], -1.22 to 13.79). Death by day 90 occurred in 164 patients (63.1%) and in 147 patients (53.5%), respectively. Kaplan-Meier mortality estimates at day 90 were 63.3% and 53.6% (hazard ratio, 1.30; 95% CI, 1.04 to 1.63). The most common complication potentially related to acute kidney injury or renal-replacement therapy was hypotension, which occurred in 179 patients (68.8%) in the intermittent group and in 183 patients (66.5%) in the continuous group. CONCLUSIONS: Among critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.).

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Publication Details

Journal
New England Journal of Medicine
Published
2026-10-14
DOI
https://doi.org/10.1056/nejmoa2608397
Citations
1
Primary Topic
Acute Kidney Injury Research
Type
article
Field-Weighted Citation Impact
4.51

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article

Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury

Laurent Argaud, Mehdi Marzouk, Béatrice La Combe, Damien Contou et al.
1 citations
New England Journal of Medicine
Acute Kidney Injury Research
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article

Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury

Laurent Argaud, Mehdi Marzouk, Béatrice La Combe, Damien Contou, Pierre-André Rodie-Talbere, Jean-Damien Ricard, Noémie Zucman, Côme Bureau, Alexis Lambour, Lucie Biard, Guillaume Thiéry, Stanislas Faguer, Christophe Camus, Antoine Kimmoun, Julien Bohé, Bruno Mégarbane, Romain Arrestier, Samir Jaber, Isabelle Durand‐Zaleski, Guillaume Chevrel, Alain Combes, Adrien Joseph, Khalil Chaïbi, Julien Cadiet, Marouane Boubaya, Nicolas Chudeau, Benjamin Glenn Chousterman, Nathan Ferrand, Pierre Bailly, Roland Amathieu, Patrick Rossignol, Guillaume Louis, Stéphane Gaudry, Maxime Desgrouas, Charlotte Salmon Gandonnière, Jean‐Pierre Quenot, Étienne de Montmollin, Clément Devautour, Arnaud Mari, Daniel Da Silva, Jonathan Nicolas, Adrien Robine, Didier Dreyfuss, Mathieu Jozwiak, Coralie Bloch
article en
1 citations

Abstract

BACKGROUND: The preferred method of renal-replacement therapy for acute kidney injury in critically ill patients remains uncertain. METHODS: In this multicenter, open-label, noninferiority trial, we randomly assigned critically ill adults with acute kidney injury who had indications for renal-replacement therapy to undergo intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. The primary outcome was a major adverse kidney event - defined as death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value - by day 90. RESULTS: The trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy. A total of 554 patients underwent randomization, with 272 patients assigned to undergo intermittent hemodialysis and 282 to undergo continuous renal-replacement therapy; 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population. A major adverse kidney event occurred by day 90 in 203 patients (78.1%) in the intermittent group and in 197 patients (71.6%) in the continuous group (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval [CI], -1.22 to 13.79). Death by day 90 occurred in 164 patients (63.1%) and in 147 patients (53.5%), respectively. Kaplan-Meier mortality estimates at day 90 were 63.3% and 53.6% (hazard ratio, 1.30; 95% CI, 1.04 to 1.63). The most common complication potentially related to acute kidney injury or renal-replacement therapy was hypotension, which occurred in 179 patients (68.8%) in the intermittent group and in 183 patients (66.5%) in the continuous group. CONCLUSIONS: Among critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.).

New England Journal of Medicine
Université Claude Bernard Lyon 1 (FR), Université d'Orléans (FR), International University of Monaco (MC), Inserm (FR), Université de Bourgogne (FR), Université Paris-Est Créteil (FR), Université Paris Cité (FR), Princess Grace Hospital Centre (MC), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire de Nice (FR), Centre Hospitalier Universitaire Henri-Mondor (FR), Sorbonne Université (FR), Hôpital Louis-Mourier (FR), Université Sorbonne Paris Nord (FR), Sorbonne Paris Cité (FR), Hôpital Cochin (FR), Centre Hospitalier Universitaire de Montpellier (FR), Centre Hospitalier Universitaire de Tours (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Assistance Publique – Hôpitaux de Paris (FR), Centre Hospitalier de Bretagne Sud (FR), Hôpital Bretonneau (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hôpital Roger Salengro (FR), Centre Hospitalier de Saint-Brieuc (FR), Centre Hospitalier Universitaire de Poitiers (FR), Hôpital Lyon Sud (FR), Centre Hospitalier Sud Francilien (FR), Centre Hospitalier Régional de Metz-Thionville (FR), Hôpital l'Archet (FR), Hôpital Lariboisière (FR), Pitié-Salpêtrière Hospital (FR), Centre Hospitalier de Gonesse (FR), Hôpital Rangueil (FR), Hôpital Edouard Herriot (FR), Centre Hospitalier du Mans (FR), Hôpital Avicenne (FR), Hôpitaux Universitaires Henri-Mondor (FR), Hôpital Ambroise-Paré (FR), Hôtel-Dieu de Paris (FR), Centre Hospitalier Annecy Genevois (FR), Centre Hospitalier Victor Dupouy (FR), Centre Hospitalier de Béthune (FR), Hôpital Saint Eloi (FR), Scientific Centre of Monaco (MC), Hôpital Saint-Louis (FR), Centre hospitalier universitaire d'Orléans (FR), Hôpital Bichat-Claude-Bernard (FR), Centre Hospitalier Saint-Denis (FR), Centre Hospitalier Universitaire de Rouen (FR), Fondation pour l’innovation en Cadiométabolisme et Nutrition (FR), Centre Hospitalier Universitaire de Rennes (FR), Hôpital Laennec (FR), Institut des Maladies Génétiques Imagine (FR), Hôpital Maison Blanche (FR), French Clinical Research Infrastructure Network (FR), Université de Rouen Normandie (FR), Université de Lorraine (FR)
Ministère de la Santé
Good health and well-being
Openalex Percentile: Top 4%
Acute Kidney Injury Research
4.51
DOISourceOpenAlex
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