Figure 1

Possible relationship between delivered dose of continuous renal replacement therapy and survival, with results from the ATN and RENAL trials illustrated. ATN doses are corrected for pre-dilution. These studies indicate a plateau response at the dose ranges examined. To reproduce these results, clinicians will need to prescribe continuous renal replacement therapy doses above the lower target dose in the trial protocols (20 or 25 mL/kg per minute) as larger periods of filter downtime can be expected outside a clinical trial environment. Below this best-practice region, survival is likely to be dose-dependent; however, the exact nature of this relationship has not been formally determined. Doses above the best-practice region are unlikely to be beneficial to unselected patients and could potentially be harmful. ATN, Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network; RENAL, Randomized Evaluation of Normal versus Augmented Level. Adapted from Kellum and Ronco [18] 2010.