Kidney Disease Research Updates
Fall 2008

Intensive Dialysis Does Not Improve Outcomes for Acute Kidney Injury

People with acute kidney injury who received intensive dialysis did not have significantly different death rates or other outcomes compared with those who received standard dialysis, according to a joint study by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the U.S. Department of Veterans Affairs (VA).

Earlier studies of people with acute kidney injury, or acute renal failure, at single medical centers suggested improved survival with more intensive dialysis, which is more costly.

Definitive Evidence

“We now have definitive evidence that intensive treatment of acute kidney injury is no more beneficial in improving treatment outcomes than the usual level of care,” said National Institutes of Health (NIH) Director Elias A. Zerhouni, M.D. “As a result, the findings of this well-designed study may help prevent unnecessary medical expenditures.”

Within 60 days after starting intensive dialysis treatment, 53.6 percent of participants died, compared with 51.5 percent of participants in the less-intensive treatment group. The study also found no significant differences between the two groups in recovery of kidney function, the failure rate of organs other than the kidneys, or the number of participants able to return to their prior living situations.

Currently, no medications effectively treat acute kidney injury. Hemodialysis and other forms of renal-replacement therapy support patients whose kidneys fail to function properly. During hemodialysis, a machine cleans waste and extra fluid from the blood when the kidneys cannot do the job.

“The main purpose of this study was to see if intensive therapy would reduce the death rate, shorten the duration of the illness, and decrease the number of new complications in other organs among patients with acute kidney injury,” said study co-author Robert A. Star, M.D., director of the NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases. “Though this was found not to be the case, it is important that we know this so we can focus future research on finding more beneficial treatment strategies.”

The Acute Renal Failure Trial Network study enrolled 1,124 critically ill patients from 17 VA medical centers and 10 university-affiliated medical centers across the United States. The study ran from November 2003 through July 2007.

The National Kidney and Urologic Diseases Information Clearinghouse has more information about kidney failure at www.kidney.niddk.nih.gov/kudiseases/topics/failure.asp.

NIH Publication No. 09–4531
December 2008

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