Intermittent hemodialysis and continuous renal replacement therapy (CRRT) appear to lead to similar clinical outcomes for patients with acute renal failure (ARF), according to researchers who reviewed 30 randomized controlled trials and eight prospective cohort studies.
The investigators, led by Marcello Tonelli, MD, of the University of Alberta in Edmonton, Canada, said they could not draw any conclusions about optimal indications for or timing of renal replacement therapy (RRT), according to a report in the Journal of the American Medical Association (2008;299:793-805).
If patients are treated with continuous venovenous hemofiltration, a dose of 35 mL/kg per hour should be provided, the authors concluded. This dose was associated with a 26% lower risk of death compared with a dose of 20 mL/kg per hour.
The authors said they believe their study is the most comprehensive review of renal replacement options for ARF. “Despite the wide variety of a available techniques, we identified few good-quality data to guide best practice,” they wrote. “Uncertainty remains about when RRT should be initiated, how much dialysis should be provided, and for how long treatment should continue.”