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The Hannover Dialysis Outcome (HAN-D-OUT) study: comparison of standard versus intensified dialysis in treatment of patients with acute kidney injury in the ICU
Critical Care volume 12, Article number: P475 (2008)
Increasing the dose of renal replacement therapy has been shown to improve survival in critically ill patients with acute kidney injury. The study objective was to assess mortality and renal recovery of patients with acute kidney injury receiving either standard or intensified dialysis therapy in the ICU.
A prospective randomized parallel group study (from 2003 to 2006). Investigators were blinded for initial group assignment; the follow-up period was 28 days. In seven ICUs of a tertiary university hospital, we studied 157 patients (570 screened) with acute kidney injury requiring renal replacement therapy without pre-existing chronic kidney disease. No patient withdrawal occurred due to adverse effects; 146 patients qualified for final intention-to-treat analysis. Participants were randomly assigned to receive either standard (that is, currently recommended) dialysis dosed to maintain plasma urea levels between 120 and150 mg/dl (20–25 mmol/l), or intensified dialysis dosed to maintain plasma urea levels below 90 mg/dl (<15 mmol/l). In the former group patients received daily dialysis, whereas in the latter group they received at least two treatments daily after initiation of renal replacement therapy. Outcome measures were survival at day 14 (primary), and survival and renal recovery at day 28 (secondary) after initiation of renal replacement therapy. Outcome measures were defined before inclusion of the first participant.
The treatment intensity differed significantly already after 24 hours (P < 0.01 for plasma urea and applied dialysis dose). No significant differences between intensified and standard treatment were seen for survival at day 14 (74.4% vs 70.0%) and day 28 (56.5% vs 60.0%), and for renal recovery amongst the survivors at day 28 (60.5% vs 59.5%).
Increasing the dose of renal replacement therapy above the currently recommended dose neither reduces mortality nor improves renal recovery in critically ill patients with acute kidney injury.
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Faulhaber-Walter, R., Kielstein, J., Vahlbruch, J. et al. The Hannover Dialysis Outcome (HAN-D-OUT) study: comparison of standard versus intensified dialysis in treatment of patients with acute kidney injury in the ICU. Crit Care 12, P475 (2008). https://doi.org/10.1186/cc6696
- Chronic Kidney Disease
- Kidney Disease
- Renal Replacement Therapy
- Acute Kidney Injury
- Group Assignment