מתוך medicontext.co.il
NEW YORK (Reuters Health) – Patients in acute renal failure benefit from daily hemodialysis, with lower mortality and shorter time to resolution, without experiencing increased hemodynamically induced morbidity, German researchers report in The New England Journal of Medicine for January 31.
Dr. Helmut Schiffl and colleagues, from the Universitat Munchen assigned 160 patients who had acute renal failure to daily hemodialysis or conventional intermittent (alternate-day) hemodialysis. Survival 14 days after last hemodialysis session was the primary study end-point. Data for 146 patients were available for analysis.
Compared with intermittent hemodialysis, daily hemodialysis resulted in better control of uremia. There were also fewer hypertensive episodes during daily hemodialysis and a faster resolution of acute renal failure compared with intermittent hemodialysis (mean 9 days versus 16 days, p = 0.001), the researchers found.
In intention-to-treat analysis, Dr. Schiffl's group found that the mortality rate for patients receiving daily hemodialysis was 28% compared with 46% for patients receiving hemodialysis every other day (p = 0.01). Multiple regression analysis revealed that alternate day hemodialysis was an independent risk factor for death, the German team reports.
"Despite fundamental differences between acute renal failure and end-stage renal disease, patients with acute renal failure are given doses of hemodialysis that would be considered inadequate even for patients with stable end-stage renal disease," the investigators write.
"Strict control of azotemia and fluid volume by means of daily hemodialysis in patients with acute renal failure may improve survival, at least among patients with an intermediate risk of death, as in our study," they add.
Dr. Schiffl and colleagues believe that "alternate-day hemodialysis should no longer be considered adequate for critically ill patients with acute renal failure."
"The results of the study by Schiffl and colleagues challenge physicians to consider daily hemodialysis in patients with acute renal failure and provide hope that better dialytic approaches may have a positive effect on the outcome in such patients," Dr. Joseph V. Bonventre, from the Massachusetts General Hospital in Charlestown, comments in a journal editorial.
"The optimal treatment of critically ill patients with acute renal failure remains to be determined," he adds
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