Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients.pdf

n engl j med 361;17 october 22, 2009 1627 The new england journal of medicine established in 1812 october 22, 2009 vol. 361 no. 17 Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients The RENAL Replacement Therapy Study Investigators* A bs tr ac t The Randomized Evaluation of Normal versus Augmented Level (RENAL) Re- placement Therapy Study is a collabora- tion of the Australian and New Zealand Intensive Care Society Clinical Trials Group and the George Institute for Inter- national Health. The members of the Writ- ing Committee for the RENAL Replace- ment Therapy Study (Rinaldo Bellomo, M.D., Alan Cass, M.D., Ph.D., Louise Cole, M.D., Ph.D., Simon Finfer, M.D., Martin Gallagher, M.D., Serigne Lo, Ph.D., Colin McArthur, M.D., Shay McGuinness, M.D., John Myburgh, M.D., Ph.D., Robyn Nor- ton, M.D., Ph.D., M.P.H., Carlos Scheink- estel, M.D., and Steve Su, Ph.D.) take re- sponsibility for the content of this article. Address reprint requests to Dr. Bellomo at ANZICS CTG, Level 3, 10 Ievers St., Carlton, VIC 3053, Australia, or at ctg@ .au. *The members of the Randomized Evalu- ation of Normal versus Augmented Level (RENAL) Replacement Therapy Study Group and their affiliations are listed in the Appendix. N Engl J Med 2009;361:1627-38. Copyright ? 2009 Massachusetts Medical Society. Background The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, de- livered at two different levels of intensity, on 90-day mortality among critically ill patients with acute kidney injury. Methods We randomly assigned critically ill adults with acute kidney injury to continuous re- nal-replacement therapy in the form of postdilution continuous venovenous hemo- diafiltration with an effluent flow of either 40 ml per kilogram of body weight per hour (higher intensity) or 25 ml per kilogram per hour (lower intensity). The primary outcome