More-intensive renal replacement therapy has no benefit in critically ill patients with acute kidney injury

This Practice Point commentary discusses the strengths and limitations of the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network study. This multicenter, prospective, randomized parallel-group trial compared two treatment regimens-intensive and less-intensive-for each of three types of renal supportive therapy: intermittent hemodialysis (IHD; used in patients who were hemodynamically stable), sustained low-efficiency dialysis, and continuous venovenous hemodiafiltration (both used in patients who were less hemodynamically stable). Overall, there was no significant improvement in patient outcomes with the more-intensive regimens, particularly for IHD. A strategy of intensive renal support in critically ill patients with acute kidney injury does not decrease mortality, accelerate recovery of kidney function, or alter the rate of nonrenal organ failure as compared with a less-intensive regimen similar to usual-care practices, and, consequently, this study will change the clinical practice of IHD in acute kidney injury.