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Previous Volume 347:895-902 September 19, 2002 Number 12 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Daugirdas, J. T. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In some parts of the world, peritoneal dialysis is widely used for renal replacement in acute renal failure. In resource-rich countries, it has been supplanted in recent years by hemodialysis and, most recently, by hemofiltration and associated techniques. The relative efficacy of peritoneal dialysis and hemofiltration is not known.

Methods We conducted an open, randomized comparison of pumped venovenous hemofiltration and peritoneal dialysis in patients with infection-associated acute renal failure in an infectious-disease referral hospital in Vietnam.

Results Seventy adult patients with severe falciparum malaria (48 patients) or sepsis (22 patients) were enrolled; 34 were assigned to hemofiltration and 36 to peritoneal dialysis. The mortality rate was 47 percent (17 patients) in the group assigned to peritoneal dialysis, as compared with 15 percent (5 patients) in the group assigned to hemofiltration (P=0.005). The rates of resolution of acidosis and of decline in the serum creatinine concentration in the group assigned to hemofiltration were more than twice those in the group assigned to peritoneal dialysis (P<0.005), and renal-replacement therapy was required for a significantly shorter period. In a multivariate analysis, the odds ratio for death was 5.1 (95 percent confidence interval, 1.6 to 16) and that for a need for future dialysis was 4.7 (95 percent confidence interval, 1.3 to 17) in the group assigned to peritoneal dialysis. The cost of hemofiltration per survivor was less than half that of peritoneal dialysis, and the cost per life saved was less than one third.

Conclusions Hemofiltration is superior to peritoneal dialysis in the treatment of infection-associated acute renal failure.

Source Information

From the Center for Tropical Diseases (N.H.P., T.T.H., N.T.H.M., T.T.H.C., L.V.C., P.P.L.) and the Wellcome Trust Clinical Research Unit (J.F., N.W., N.D.), Center for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine, John Radcliffe Hospital, Oxford, United Kingdom (J.F., N.W., N.D.); and the Renal Unit, Churchill Hospital, Headington, Oxford, United Kingdom (C.W.).

Address reprint requests to Dr. Day at the Centre for Tropical Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom, or at nick.day{at}ndm.ox.ac.uk.

Full Text of this Article

Related Letters:

Hemofiltration and Peritoneal Dialysis in Infection-Associated Acute Renal Failure
Rao P. S., Modi K. S., Casserly L. F., Fruchter O., Bazari H., Phu N. H., Hien T. T., Day N.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:858-860, Feb 27, 2003. Correspondence

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