6/28/23, 12:48 AM ATN Pathway Feedback Search Clinical Topics Home Studies ATN ATN Disease Acute kidney injury Trial question What is the effect of intensive renal support in critically ill patients with AKI? Study design Multi-center Open label RCT Population Characteristics of study participants 29.0% female N = 1124 71.0% male 1124 patients (330 female, 793 male) Inclusion criteria: critically ill patients with AKI and failure of at least one nonrenal organ or sepsis Key exclusion criteria: > 1 hemodialysis treatment or > 24 hours of continuous RRT, prior kidney transplant, pregnancy, moribund state, acute renal failure due to an etiology other than acute tubular necrosis, or weight > 128.5 kg Interventions N=563 intensive RRT (intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 mL/kg of body weight per hour) N=561 less-intensive RRT (the corresponding treatments provided thrice weekly and at 20 mL/kg/hour) https://web.pathway.md/studies/recQ5EoBLfn67RwyZ 1/2 6/28/23, 12:48 AM ATN Pathway Primary outcome Death at 60 days 53.6 % 53.6 51.5 40.2 % 26.8 % 13.4 % No significant difference 0.0 % Intensive renal replacement therapy Less-intensive renal replacement therapy No significant difference in death at 60 days (53.6% vs. 51.5%; OR 1.09, 95% CI 0.86 to 1.4) Secondary outcomes Borderline significant decrease in the rate of recovery of kidney function by day 28 (24.3% vs. 27.4%; OR 0.03, 95% CI 0.02 to 0.07) No significant difference in in-hospital death (51.2% vs. 48%; OR 1.15, 95% CI 0.9 to 1.47) Safety outcomes No significant differences in serious adverse event (51.0% vs. 49.9%, p=0.72) and hypotension requiring treatment discontinuation (9.8% vs. 8.7%, p=0.55). Significant differences in hypokalemia (7.5% vs. 4.5%, p = 0.03) and hypophosphatemia (17.6% vs. 10.9%, p = 0.001). Conclusion In critically ill patients with AKI and failure of at least one nonrenal organ or sepsis, intensive RRT was not superior to less-intensive RRT with respect to death at 60 days. Reference VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008 Jul 3;359(1):7-20. Open reference URL https://web.pathway.md/studies/recQ5EoBLfn67RwyZ 2/2