Article thumbnail
Location of Repository

Dialysis dose in acute kidney injury: no time for therapeutic nihilism – a critical appraisal of the Acute Renal Failure Trial Network study

By Claudio Ronco, Dinna Cruz, Helen Oudemans van Straaten, Patrick Honore, Andrew House, Du Bin and Noel Gibney


The optimal dialysis dose for acute kidney injury is a matter of great controversy. Clinical trials, predominantly single-center studies, have shown conflicting results. The Acute Renal Failure Trial Network (ATN) Study was designed to compare clinical outcomes between patients allocated to an intensive dose versus a less-intensive dose of renal replacement therapy. Recently, the results of this large randomized controlled multicenter study were published. The present article will discuss certain aspects of this trial: the overall design, the baseline patient characteristics, and comparison of the results with earlier studies. Finally, the article will address the implications of the ATN Study results for clinical practice

Topics: Viewpoint
Publisher: BioMed Central
OAI identifier:
Provided by: PubMed Central

Suggested articles


  1. (2005). Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA
  2. (1997). Collins AJ: Quantification of hemodialysis: analysis of methods and relevance to clinical outcome. Blood Purif
  3. (2002). Daily hemodialysis and the outcome of acute renal failure.
  4. (2006). Dhainaut JF; Hemodiafe Study Group: Continuous venovenous haemodiafiltration versus intermittent hemodialysis for acute renal failure patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet
  5. (1981). Effect of the hemodialysis prescription of patient morbidity: report from the National Cooperative Dialysis Study.
  6. (1994). Effects of dose of dialysis on morbidity and mortality.
  7. (2002). Effects of early high-volume continuous veno-venous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med
  8. (2007). Kielstein JT: The Hannover-Dialysis-Outcome (HANDOUT)-study: comparison of conventional versus intensified extended daily dialysis in treatment of patients with acute renal failure on the intensive-care unit [abstract].
  9. (2008). KM: Standard versus high-dose CVVHDF for ICU-related acute renal failure.
  10. (2000). LaGreca G: Effects of different doses in continuous venovenous hemofiltration on outcomes in acute renal failure: a prospective, randomized trial. Lancet
  11. (1992). LW: Inadequate dialysis increases gross mortality rate.
  12. (2007). Martling CR: Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med
  13. (1999). Measurement of the delivery of dialysis in acute renal failure. Kidney Int
  14. (2008). Operational characteristics of continuous renal replacement therapy modalities used for critically ill patients with acute kidney injury.
  15. (2007). Oudemans-Van Straaten HM, Ronco C; Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators Writing Committee: Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury.
  16. (2008). Outcome comparisons of intermittent and continuous therapies in acute kidney injury: what do they mean?
  17. (2006). PY: Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int
  18. (2006). Recent clinical advances in the management of critically ill patients with acute renal failure. Blood Purif
  19. (2004). Ronco C: Continuous renal replacement techniques. Contrib Nephrol
  20. (2001). Ronco C: Factors influencing therapy delivery in acute dialysis. Contrib Nephrol
  21. (1985). Sargent FA: A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int
  22. (1998). The current place of urea kinetic modeling with respect to different dialysis modalities. Nephrol Dial Transplant
  23. (2008). The VA/NIH Acute Renal Failure Trial Network: Intensity of renal support in critically ill patients with acute kidney injury.
  24. (1996). Thijs LG: The SOFA (Sepsisrelated Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med
  25. (2008). What if the ATN trial …?
  26. (1979). WK: Quantitative indices of clinical uremia. Kidney Int

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.