Intermittent dialysis tied to more ICU deaths in French trial
Critically ill patients with acute kidney injury who started on intermittent dialysis were more likely to die than those on continuous treatment, a French trial found. By 90 days, 63.1% of the intermittent group had died, compared with 53.5%, MedPage Today reported. The trial was stopped early because of the deaths.
Critically ill patients with acute kidney injury who began treatment with intermittent hemodialysis had a higher risk of death than those started on continuous kidney replacement therapy, according to a French trial reported by Healio and MedPage Today. The study was published in The New England Journal of Medicine.
The ICRAKI trial randomly assigned critically ill adults in 42 French intensive care units to start either intermittent hemodialysis or continuous therapy between 2023 and 2025, Healio reported. The main analysis included 535 patients, both outlets reported.
By day 90, 63.1% of patients in the intermittent group had died, compared with 53.5% in the continuous group, MedPage Today reported. That was about a 30% higher risk of death, both outlets reported. The trial's data and safety monitoring board stopped it early because of the mortality signal, MedPage said.
The trial's main goal, a combined measure of death, dependence on dialysis or worse kidney function by day 90, did not differ significantly between the groups, at 78.1% and 71.6%, Healio reported.
Lead author Stéphane Gaudry told Healio that continuous techniques "should probably be preferred, at least for the first few days after dialysis initiation" in critically ill patients with multiorgan failure and severe kidney injury. He said the most striking difference between the two approaches was in deaths rather than kidney outcomes.
The researchers called the higher death rate "unexpected" and "not readily explained," MedPage reported. They noted that stopping early may have overstated the size of the effect. In an editorial, Dr. Paul Palevsky of the University of Pittsburgh wrote that the real question is how best to combine the different therapies, MedPage said.
Gaudry told Healio that future studies should help define when patients can safely switch from continuous to intermittent dialysis after the first few days.
What we know: Starting with intermittent dialysis was tied to more deaths in this trial, which was stopped early.
What we don't: Why death rates differed, and which method is best after the first few days.
Where outlets agree Healio and MedPage Today both report that the ICRAKI trial found a higher risk of death with intermittent hemodialysis and was stopped early.
Where they differ The outlets cited here report the same key facts so far.