Intermittent hemodialysis not noninferior to continuous renal-replacement therapy

by Elana Gotkine

edited by Gaby Clark, reviewed by Alexander Pol

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Intermittent hemodialysis as an initial treatment approach is not noninferior to continuous renal-replacement therapy (CRRT) among critically ill patients with acute kidney injury (AKI) with indications for renal replacement therapy, according to a study published online Oct. 14 in the New England Journal of Medicine.

Stéphane Gaudry, M.D., Ph.D., from Assistance Publique-Hôpitaux de Paris in France, and colleagues conducted a multicenter, open-label, noninferiority trial involving critically ill adults with AKI who had indications for renal-replacement therapy. Participants were randomly assigned to undergo initial treatment with intermittent hemodialysis or CRRT (272 and 282 patients, respectively).

After sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with CRRT, the trial was stopped early. The researchers found that a major adverse kidney event occurred by day 90 in 78.1% and 71.6% of patients in the intermittent and continuous groups (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval, −1.22 to 13.79).

Death by day 90 occurred in 63.1% and 53.5% of patients in the intermittent and continuous groups, respectively. At day 90, Kaplan-Meier mortality estimates were 63.3% and 53.6% (hazard ratio, 1.30). Hypotension was the most common complication potentially related to AKI or renal-replacement therapy, which occurred in 68.8% and 66.5% of patients in the intermittent and continuous groups, respectively.

"Because the trial was stopped early, the magnitude of the mortality difference should be interpreted with caution," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

Publication details

Stéphane Gaudry et al., Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury, New England Journal of Medicine (2026). DOI: 10.1056/nejmoa2608397

Journal information: New England Journal of Medicine

Key medical concepts

Acute Kidney Injury

Clinical categories

NephrologyCritical care medicine Who's behind this story?

Gaby Clark

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