Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Aug 8;11(8):1335-1342.
doi: 10.2215/CJN.10991015. Epub 2016 Jul 22.

Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

Finnian R Mc Causland  1   2 , Josephine Asafu-Adjei  3 , Rebecca A Betensky  4 , Paul M Palevsky  5   6 , Sushrut S Waikar  1   2
Affiliations
Randomized Controlled Trial

Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

Finnian R Mc Causland et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Intensive RRT may have adverse effects that account for the absence of benefit observed in randomized trials of more intensive versus less intensive RRT. We wished to determine the association of more intensive RRT with changes in urine output as a marker of worsening residual renal function in critically ill patients with severe AKI.

Design, setting, participants, & measurements: The Acute Renal Failure Trial Network Study (n=1124) was a multicenter trial that randomized critically ill patients requiring initiation of RRT to more intensive (hemodialysis or sustained low-efficiency dialysis six times per week or continuous venovenous hemodiafiltration at 35 ml/kg per hour) versus less intensive (hemodialysis or sustained low-efficiency dialysis three times per week or continuous venovenous hemodiafiltration at 20 ml/kg per hour) RRT. Mixed linear regression models were fit to estimate the association of RRT intensity with change in daily urine output in survivors through day 7 (n=871); Cox regression models were fit to determine the association of RRT intensity with time to ≥50% decline in urine output in all patients through day 28.

Results: Mean age of participants was 60±15 years old, 72% were men, and 30% were diabetic. In unadjusted models, among patients who survived ≥7 days, mean urine output was, on average, 31.7 ml/d higher (95% confidence interval, 8.2 to 55.2 ml/d) for the less intensive group compared with the more intensive group (P=0.01). More intensive RRT was associated with 29% greater unadjusted risk of decline in urine output of ≥50% (hazard ratio, 1.29; 95% confidence interval, 1.10 to 1.51).

Conclusions: More intensive versus less intensive RRT is associated with a greater reduction in urine output during the first 7 days of therapy and a greater risk of developing a decline in urine output of ≥50% in critically ill patients with severe AKI.

Keywords: Acute kidney injury; Humans; Randomized trials as topic; critical illness; hemodialysis; renal dialysis; renal replacement therapy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Box plots of daily urine output according to RRT intensity. Less intensive is shown in white, and more intensive is shown in gray. The top line of each box represents the 75th percentile, the middle line represents the 50th percentile, and the bottom line represents the 25th percentile.
Figure 2.
Figure 2.
Kaplan–Meier survival estimates for the association of more intensive versus less intensive RRT with the decline in urine output to ≥50% from baseline.
See this image and copyright information in PMC

Comment in

References

    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators : Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 294: 813–818, 2005 - PubMed
    1. Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T: Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: A population-based study. Crit Care 9: R700–R709, 2005 - PMC - PubMed
    1. Turney JH, Marshall DH, Brownjohn AM, Ellis CM, Parsons FM: The evolution of acute renal failure, 1956-1988. Q J Med 74: 83–104, 1990 - PubMed
    1. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: A prospective randomised trial. Lancet 356: 26–30, 2000 - PubMed
    1. Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, Martin PY: Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int 70: 1312–1317, 2006 - PubMed

Publication types