Lancet. 2006 Jul 29;368(9533):379-85.

Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T,
Pallot JL, Chiche JD, Taupin P, Landais P, Dhainaut JF; Hemodiafe Study Group.

Department of Intensive Care, Cochin Port-Royal University Hospital, René
Descartes University, Paris, France. This email address is being protected from spambots. You need JavaScript enabled to view it.

BACKGROUND: Whether 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. METHODS: Our 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. FINDINGS: Rate 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. INTERPRETATION: These 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.