From Our 2008 Archives

More Dialysis Not Better in Acute Kidney Injury

By Steven Reinberg
HealthDay Reporter

TUESDAY, May 20 (HealthDay News) — Intensive kidney dialysis for patients with acute kidney injury does not reduce death, improve kidney function, or reduce the rate of organ failure, a new study finds.

Acute kidney injury is a complication often seen in critically ill patients. Approximately 2 percent to 7 percent of hospitalized patients, and 35 percent of critically ill patients, will suffer from acute kidney injury. For patients with acute kidney injury, the death rate is approximately 50 percent to 80 percent.

"In acute kidney injury, there is no specific treatment to reverse kidney function," said lead researcher Dr. Paul M. Palevsky, a professor of medicine at the University of Pittsburgh. "The treatment is predominantly supportive."

The common teaching has been that in people who survived the illness, most will recover kidney function, Palevsky said. Previous studies have suggested that more dialysis improved outcomes. "So, we did the study to see if that was the case," Palevsky explained.

"Increasing the dose of dialysis beyond what is considered normal did not improve outcomes," Palevsky said. "There was no improvement in survival, no improvement in recovery of renal function, and no improvement in the course of non-renal organ failure. So, more was not better."

The report was released early, in the May 20 online edition of the New England Journal of Medicine, to coincide with a presentation at the American Thoracic Society's International Conference, in Toronto.

In the study, Palevsky's team randomly assigned 1,124 patients with acute kidney injury to receive intensive or less intensive dialysis.

Patients who received intensive renal therapy had dialysis six times a week, while patients who received less intensive renal therapy, underwent dialysis three times a week.

The researchers found that the rate of death, after two months, was 53.6 percent among patients receiving intensive renal therapy and 51.5 percent among patients receiving less intensive therapy.

Moreover, there was no difference between the groups in the length of time renal replacement therapy was given, the recovery of kidney function or failure of other organs, the researchers found.

"The evidence suggests that doing it well, but not necessarily doing more of it, is what is best for patients," Palevsky said.

One expert said that the results of the study will change how patients with acute renal injury are treated.

"This is an important study that will change our practice," said Dr. Ajay K. Singh, from the Renal Division at Brigham and Women's Hospital and an associate professor of medicine at Harvard Medical School in Boston.

At Brigham, for example, Singh said that based on previously published studies, they were treating patients more intensively. "Based on this study, we will go back to adopting the less-intensive approach," he said

"However, it is disappointing that we are unable to identify a therapeutic strategy that improves the survival of our patients with acute kidney injury," Singh said. "This study should further underscore the importance of developing novel strategies to improve outcomes in these patients."

SOURCES: Paul M. Palevsky, M.D., professor, medicine, University of Pittsburgh; Ajay K. Singh, M.B., Renal Division, Brigham and Women's Hospital, and associate professor, medicine, Harvard Medical School, Boston; May 20, 2008, New England Journal of Medicine, online

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