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The Expression of Concern has been removed: Drazen et al., N Engl J Med 2003;349(20):1965.

Previous Volume 346:305-310 January 31, 2002 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Bonventre, J. V. Editorial by Drazen, J. M. Editorial by Drazen, J. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Intermittent hemodialysis is widely used as renal-replacement therapy in patients with acute renal failure, but an adequate dose has not been defined. We performed a prospective study to determine the effect of daily intermittent hemodialysis, as compared with conventional (alternate-day) intermittent hemodialysis, on survival among patients with acute renal failure.

Methods A total of 160 patients with acute renal failure were assigned to receive daily or conventional intermittent hemodialysis. Survival was the primary end point of the study. The duration of acute renal failure and the frequency of therapy-related complications were secondary end points.

Results The two study groups were similar with respect to age, sex, cause and severity of acute renal failure, medical or surgical intensive care setting, and the score on the Acute Physiology, Age, and Chronic Health Evaluation. Daily hemodialysis resulted in better control of uremia, fewer hypotensive episodes during hemodialysis, and more rapid resolution of acute renal failure (mean [±SD], 9±2 vs. 16±6 days; P=0.001) than did conventional hemodialysis. The mortality rate, according to the intention-to-treat analysis, was 28 percent for daily dialysis and 46 percent for alternate-day dialysis (P=0.01). In a multiple regression analysis, less frequent hemodialysis (on alternate days, as opposed to daily) was an independent risk factor for death.

Conclusions The high mortality rate among critically ill patients with acute renal failure who require renal-replacement therapy is related to both coexisting conditions and uremic damage to other organ systems. Intensive hemodialysis reduces mortality without increasing hemodynamically induced morbidity.

Source Information

From the Department of Nephrology, Medizinische Klinik and Medizinische Poliklinik Innenstadt, Universität München, Munich, Germany.

Address reprint requests to Professor Schiffl at Medizinische Klinik Innenstadt der Universität München, Ziemssenstr. 1, D-80336 Munich, Germany, or at hschiffl{at}medinn.med.uni-muenchen.de.

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