Key result
Intermittent hemodialysis fails noninferiority to CRRT for major adverse kidney events and increases mortality.
Why the study?
Does intermittent hemodialysis reduce major adverse kidney events by day 90 in critically ill adults with acute kidney injury compared to continuous renal-replacement therapy?
RCT (n=554)
Open-label
Randomly assigned
Yes
Does intermittent hemodialysis reduce major adverse kidney events by day 90 in critically ill adults with acute kidney injury compared to continuous renal-replacement therapy?
In critically ill adults with acute kidney injury requiring renal-replacement therapy, initial treatment with intermittent hemodialysis was associated with higher mortality and was not noninferior to continuous renal-replacement therapy for major adverse kidney events.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Gaudry and colleagues note that the higher mortality rate for intermittent hemodialysis was "...unexpected on the basis of data from previous literature," emphasizing that "...because the trial was stopped early, the magnitude of the mortality difference should be interpreted with caution.”
Not noninferior with higher mortality; challenges prior equivalence assumptions and supports initial continuous therapy in severe AKI.
BackgroundThe preferred method of renal-replacement therapy for acute kidney injury in critically ill patients remains uncertain. MethodsIn this multicenter, open-label, noninferiority trial, we randomly assigned critically ill adults with acute kidney injury who had indications for renal-replacement therapy to undergo intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. The primary outcome was a major adverse kidney event — defined as death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value — by day 90. ResultsThe trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy. A total of 554 patients underwent randomization, with 272 patients assigned to undergo intermittent hemodialysis and 282 to undergo continuous renal-replacement therapy; 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population. A major adverse kidney event occurred by day 90 in 203 patients (78.1%) in the intermittent group and in 197 patients (71.6%) in the continuous group (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval [CI], −1.22 to 13.79). Death by day 90 occurred in 164 patients (63.1%) and in 147 patients (53.5%), respectively. Kaplan–Meier mortality estimates at day 90 were 63.3% and 53.6% (hazard ratio, 1.30; 95% CI, 1.04 to 1.63). The most common complication potentially related to acute kidney injury or renal-replacement therapy was hypotension, which occurred in 179 patients (68.8%) in the intermittent group and in 183 patients (66.5%) in the continuous group. ConclusionsAmong critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.)
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Gaudry et al. (2026) conducted an RCT in Acute kidney injury (n=554). Intermittent hemodialysis vs. Continuous renal-replacement therapy was evaluated on Major adverse kidney event (death, dependence on renal-replacement therapy, or serum creatinine >25% above baseline) by day 90 (adjusted absolute risk difference 6.28 percentage points, 95% CI -1.22 to 13.79). Intermittent hemodialysis was not shown to be noninferior to continuous renal-replacement therapy for major adverse kidney events (78.1% vs 71.6%) and was associated with higher mortality.
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