***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND There is uncertainty on the effect of different dialysis modalities for the treatment of patients with acute kidney injury ( AKI ) , admitted to the intensive care unit ( ICU ) . This controlled clinical trial performed in the framework of the multicentre SHARF 4 study ( Stuivenberg Hospital Acute Renal Failure ) aim ed to investigate the outcome in patients with AKI , stratified according to severity of disease and r and omized to different treatment options . METHODS This was a multicentre prospect i ve r and omized controlled trial with stratification according to severity of disease expressed by the SHARF score . ICU patients were eligible for inclusion when serum creatinine was > 2 mg/dL , and RRT was initiated . The selected patients were r and omized to intermittent ( IRRT ) or continuous renal replacement therapy ( CRRT ) . RESULTS A total of 316 AKI patients were r and omly assigned to IRRT ( n = 144 ) or CRRT ( n = 172 ) . The mean age was 66 ( range 18 - 96 ) ; 59 % were male . Intention-to-treat analysis revealed a mortality of 62.5 % in IRRT compared to 58.1 % in CRRT ( P = 0.430 ) . No difference between IRRT and CRRT could be observed in the duration of ICU stay or hospital stay . In survivors , renal recovery at hospital discharge was comparable between both groups . Multivariate analysis , including the SHARF score , APACHE II and SOFA scores for correction of disease severity , showed no difference in mortality between both treatment modalities . This result was confirmed in pre-specified subgroup analysis ( elderly , patients with sepsis , heart failure , ventilation ) and after exclusion of possible confounders ( early mortality , delayed ICU admission ) . CONCLUSIONS Modality of RRT , either CRRT or IRRT , had no impact on the outcome in ICU patients with AKI . Both modalities need to be considered as complementary in the treatment of AKI ( Clinical Trial : SHARF 4 , NCT00322933 , http:// Clinical Trials.gov ) BACKGROUND Despite the widespread use of continuous renal replacement therapy in critically ill patients with acute renal failure ( ARF ) , there are few data supporting its benefits over conventional intermittent hemodialysis ( IHD ) . We sought to analyze differences in survival between modalities in a study that compared continuous venovenous hemodialysis ( CVVHD ) with IHD . METHODS Eighty critically ill patients with ARF requiring dialysis were r and omized after stratification by severity of illness to treatment with CVVHD or IHD .  RESULTS There were no differences in survival or renal recovery between groups . In patients who died , mean survival time was 10.7 + /- 11.2 days for the IHD group versus 14.3 + /- 16.1 days for the CVVHD group ( P = not significant ) . There was greater net volume removal in the CVVHD group during 72 hours . Declines in urine output during 72 hours were similar between groups . Mean arterial pressure off and on dialysis therapy was analyzed retrospectively . There was a significant decrease in mean arterial pressure for patients on IHD therapy not seen in those on CVVHD therapy , but this did not lead to a survival advantage . CONCLUSION Despite greater volume control , CVVHD did not lead to an improvement in survival , preservation of urine output , or renal recovery compared with IHD in patients with ARF Introduction The optimal dialysis dose for the treatment of acute kidney injury ( AKI ) is controversial . We sought to evaluate the relationship between renal replacement therapy ( RRT ) dose and outcome . Methods We performed a prospect i ve multicentre observational study in 30 intensive care units ( ICUs ) in eight countries from June 2005 to December 2007 . Delivered RRT dose was calculated in patients treated exclusively with either continuous RRT ( CRRT ) or intermittent RRT ( IRRT ) during their ICU stay . Dose was categorised into more-intensive ( CRRT ≥ 35 ml/kg/hour , IRRT ≥ 6 sessions/week ) or less-intensive ( CRRT < 35 ml/kg/hour , IRRT < 6 sessions/week ) . The main outcome measures were ICU mortality , ICU length of stay and duration of mechanical ventilation . Results Of 15,200 critically ill patients admitted during the study period , 553 AKI patients were treated with RRT , including 338 who received CRRT only and 87 who received IRRT only . For CRRT , the median delivered dose was 27.1 ml/kg/hour ( interquartile range ( IQR ) = 22.1 to 33.9 ) . For IRRT , the median dose was 7 sessions/week ( IQR = 5 to 7 ) . Only 22 % of CRRT patients and 64 % of IRRT patients received a more-intensive dose . Crude ICU mortality among CRRT patients were 60.8 % vs. 52.5 % ( more-intensive vs. less-intensive groups , respectively ) . In IRRT , this was 23.6 vs. 19.4 % , respectively . On multivariable analysis , there was no significant association between RRT dose and ICU mortality ( Odds ratio ( OR ) more-intensive vs. less-intensive : CRRT OR = 1.21 , 95 % confidence interval ( CI ) = 0.66 to 2.21 ; IRRT OR = 1.50 , 95 % CI = 0.48 to 4.67 ) . Among survivors , shorter ICU stay and duration of mechanical ventilation were observed in the more-intensive RRT groups ( more-intensive vs. less-intensive for all : CRRT ( median ) : 15 ( IQR = 8 to 26 ) vs. 19.5 ( IQR = 12 to 33.5 ) ICU days , P = 0.063 ; 7 ( IQR = 4 to 17 ) vs. 14 ( IQR = 5 to 24 ) ventilation days , P = 0.031 ; IRRT : 8 ( IQR = 5.5 to 14 ) vs. 18 ( IQR = 13 to 35 ) ICU days , P = 0.008 ; 2.5 ( IQR = 0 to 10 ) vs. 12 ( IQR = 3 to 24 ) ventilation days , P = 0.026 ) . Conclusions After adjustment for multiple variables , these data provide no evidence for a survival benefit afforded by higher dose RRT . However , more-intensive RRT was associated with a favourable effect on ICU stay and duration of mechanical ventilation among survivors . This result warrants further exploration . Trial Registration Cochrane Renal Group ( CRG110600093 ) Among critically ill patients , acute kidney injury ( AKI ) requiring dialysis is associated with mortality rates generally in excess of 50 % . Continuous renal replacement therapies ( CRRT ) often are recommended and widely used , although data to support its superiority over intermittent hemodialysis ( IHD ) are lacking . Data from the Program to Improve Care in Acute Renal Disease ( PICARD ) , a multicenter observational study of AKI , were analyzed . Among 398 patients who required dialysis  , the risk for death within 60 d was examined by assigned initial dialysis modality ( CRRT [ n = 206 ] versus IHD [ n = 192 ] ) using st and ard Kaplan-Meier product limit estimates , proportional hazards ( " Cox " ) regression methods , and a propensity score approach to account for selection effects . Crude survival rates were lower for patients who were treated with CRRT than IHD ( survival at 30 d 45 versus 58 % ; P = 0.006 ) . Adjusted for age , hepatic failure , sepsis , thrombocytopenia , blood urea nitrogen , and serum creatinine and stratified by site , the relative risk for death associated with CRRT was 1.82 ( 95 % confidence interval 1.26 to 2.62 ) . Further adjustment for the propensity score did not material ly alter the association ( relative risk 1.92 ; 95 % confidence interval 1.28 to 2.89 ) . Among critically ill patients with AKI , CRRT was associated with increased mortality . Although the results could reflect residual confounding by severity of illness , these data provide no evidence for a survival benefit afforded by CRRT . Larger , prospect i ve , r and omized clinical trials to compare CRRT and IHD in severe AKI are needed Introduction Acute kidney injury ( AKI ) is associated with a high mortality of up to 60 % . The mode of renal replacement therapy ( intermittent versus continuous ) has no impact on patient survival . Sustained low efficiency dialysis using a single-pass batch dialysis system ( SLED-BD ) has recently been introduced for the treatment of dialysis-dependent AKI . To date , however , only limited evidence is available in the comparison of SLED-BD versus continuous veno-venous hemofiltration ( CVVH ) in intensive care unit ( ICU ) patients with AKI . Methods Prospect i ve , r and omized , interventional , clinical study at a surgical intensive care unit of a university hospital . Between 1 April 2006 and 31 January 2009 , 232 AKI patients who underwent renal replacement therapy ( RRT ) were r and omized in the study . Follow-up was assessed until 30 August 2009 . Patients were either assigned to 12-h SLED-BD or to 24-h predilutional CVVH . Both therapies were performed at a blood flow of 100 to 120 ml/min . Results 115 patients were treated with SLED-BD  ( total number of treatments n = 817 ) and 117 patients with CVVH ( total number of treatments n = 877).The primary outcome measure , 90-day mortality , was similar between groups ( SLED : 49.6 % vs. CVVH : 55.6 % , P = 0.43 ) . Hemodynamic stability did not differ between SLED-BD and CVVH , whereas patients in the SLED-BD group had significantly fewer days of mechanical ventilation ( 17.7 ± 19.4 vs. 20.9 ± 19.8 , P = 0.047 ) and fewer days in the ICU ( 19.6 ± 20.1 vs. 23.7 ± 21.9 , P = 0.04 ) . Patients treated with SLED needed fewer blood transfusions ( 1,375 ± 2,573 ml vs. 1,976 ± 3,316 ml , P = 0.02 ) and had a substantial reduction in nursing time spent for renal replacement therapy ( P < 0.001 ) result ing in lower costs . Conclusions SLED-BD was associated with reduced nursing time and lower costs compared to CVVH at similar outcomes . In the light of limited health care re sources , SLED-BD offers an attractive alternative for the treatment of AKI in ICU patients .Trial registration Clinical Trials.gov BACKGROUND Acute renal failure ( ARF ) requiring dialysis in critically ill patients is associated with an in-hospital mortality rate of 50 to 80 % . The worldwide st and ard for renal replacement therapy is intermittent hemodialysis ( IHD ) . Continuous hemodialysis and hemofiltration techniques have recently emerged as alternative modalities . These two therapies have not been directly compared . METHODS A multicenter , r and omized , controlled trial was conducted comparing two dialysis modalities ( IHD vs. continuous hemodiafiltration ) for the treatment of ARF in the intensive care unit ( ICU ) . One hundred sixty-six patients were r and omized . Principal outcome measures were ICU and hospital mortality , length of stay , and recovery of renal function . RESULTS Using intention-to-treat analysis , the overall ICU and in-hospital mortalities were 50.6 and 56.6 % , respectively . Continuous therapy was associated with an increase in ICU ( 59.5 vs. 41.5 % , P < 0.02 ) and in-hospital ( 65.5 vs. 47.6 % , P < 0.02 ) mortality relative to intermittent dialysis .  Median ICU length of stay from the time of nephrology consultation was 16.5 days , and complete recovery of renal function was observed in 34.9 % of patients , with no significant group differences . Despite r and omization , there were significant differences between the groups in several covariates independently associated with mortality , including gender , hepatic failure , APACHE II and III scores , and the number of failed organ systems , in each instance biased in favor of the intermittent dialysis group . Using logistic regression to adjust for the imbalances in group assignment , the odds of death associated with continuous therapy was 1.3 ( 95 % CI , 0.6 to 2.7 , P = NS ) . A detailed investigation of the r and omization process failed to explain the marked differences in patient assignment . CONCLUSIONS A r and omized controlled trial of alternative dialysis modalities in ARF is feasible . Despite the potential advantages of continuous techniques , this study provides no evidence of a survival benefit of continuous hemodiafiltration compared with IHD . This study did not control for other major clinical decisions or other supportive management strategies that are widely variable ( for example , nutrition support , hemodynamic support , timing of initiation , and dose of dialysis ) and might material ly influence outcomes in ARF . St and ardization of several aspects of care or extremely large sample sizes will be required to answer optimally the 
    Output:
    
Conclusions : We did not find a definitive advantage for any RRT modality on short‐term patient or kidney survival .
HIGHLIGHTSA systematic review describing renal replacement modalities for critical care .
No patient or kidney survival advantage was found for any of the modalities .