• Christophe Vinsonneau, Christophe Camus, Alain Combes, Marie Alyette Costa de Beauregard, Kada Klouche, Thierry Boulain, Jean-Louis Pallot, Jean-Daniel Chiche, Pierre Taupin, Paul Landais, Jean-François Dhainaut, and Hemodiafe Study Group.
• Department of Intensive Care, Cochin Port-Royal University Hospital, René Descartes University, Paris, France. christophe.vinsonneau@cch.aphp.fr
• Lancet. 2006 Jul 29; 368 (9533): 379-85.

BackgroundWhether continuous renal replacement therapy is better than intermittent haemodialysis for the treatment of acute renal failure in critically ill patients is controversial. In this study, we compare the effect of intermittent haemodialysis and continuous venovenous haemodiafiltration on survival rates in critically ill patients with acute renal failure as part of multiple-organ dysfunction syndrome.MethodsOur prospective, randomised, multicentre study took place between Oct 1, 1999, and March 3, 2003, in 21 medical or multidisciplinary intensive-care units from university or community hospitals in France. Guidelines were provided to achieve optimum haemodynamic tolerance and effectiveness of solute removal in both groups. The two groups were treated with the same polymer membrane and bicarbonate-based buffer. 360 patients were randomised, and the primary endpoint was 60-day survival based on an intention-to-treat analysis.FindingsRate of survival at 60-days did not differ between the groups (32% in the intermittent haemodialysis group versus 33% in the continuous renal replacement therapy group [95 % CI -8.8 to 11.1,]), or at any other time.InterpretationThese data suggest that, provided strict guidelines to improve tolerance and metabolic control are used, almost all patients with acute renal failure as part of multiple-organ dysfunction syndrome can be treated with intermittent haemodialysis.

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