Dose of intermittent hemodialysis (IHD) and outcome of acute renal failure (ART): A prospective randomized study.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:290A 1997
Whereas there are guidelines for dialysis adequacy in the chronic renal failure population, three are none for patients with acute renal failure. At this meeting, Depner et al showed that session Kt/V in acute dialysis is typically 0.82 single pool and only 0.68 equilibrated. It is inconceivable that patients with ARF would require less dialysis than chronic stable patients, thus it is possible even likely, that patients with ARF being dialyzed on a qod (alternate day) schedule are being markedly underdialyzed. In this abstract, Schiffl et al put this concept to a test using a randomized trial design.
72 patients with ARF were randomized to either daily or alternate day (qod) dialysis. Groups at baseline were deemed comparable in retrospect using the APACHE II scores. Only high flux biocompatible membranes were used.
Overall mortality, length of follow-up unspecified, was 21% in the daily HD group and 47% in the alternate day dialysis group, a finding that was statistically significant. When weekly Kt/V urea was compared in an apparent post hoc analysis, patients with a weekly Kt/V urea > 6 had a mortality of only 16%, vs. a mortality of 57% in patients with a weekly Kt/V urea under 3.0. The conclusion is, that survival in ARF patients can be markedly improved by increasing the amount of dialysis.
Comment: This study sounds too good to be true, and does not agree with a previous paper by Conger et al. Also, last year at ASN, Ravi Mehta found that mortality with intermittent hemodialysis (IHD), presumably alternate day, was similar to that with continuous therapy (CRRT). So this study would mean that daily IHD may have a far superior survival to CRRT by transitivity. Maybe. This study URGENTLY needs to be confirmed. If true, then it has identified a tremendously important, easy method to increase survival dramatically in ARF patients. I have been doing this in my own practice for the past two years, and it seems that some patients have indeed pulled through and survived who based on past experience were not expected to survive. I don't look at the BUN or creatinine, but measure residual clearance. As long as the latter is low, I dialyze 6x/week, even if the serum BUN and creatinine reach quite low levels. To me, this is potentially the most important clinical abstract at the '97 ASN meeting! (John T. Daugirdas, M.D., University of Illinois at Chicago)
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ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : (Intermittent) dialysis for ARF
CRF: Problem Areas : Outcomes (Morbidity, Mortality)