Intermittent Hemodialysis Linked to Higher Mortality in Acute Kidney Injury Trial
- Findings published in the New England Journal of Medicine indicate that intermittent hemodialysis did not demonstrate noninferiority compared to continuous renal-replacement therapy for critically ill patients suffering from...
- In an intention-to-treat analysis of 535 patients, a major adverse kidney event by day 90 occurred in 78.1% of the intermittent group versus 71.6% of the continuous group,...
- By day 90, deaths occurred in 63.1% of the intermittent arm compared with 53.5% of the continuous arm.
Findings published in the New England Journal of Medicine indicate that intermittent hemodialysis did not demonstrate noninferiority compared to continuous renal-replacement therapy for critically ill patients suffering from acute kidney injury, and it was linked to an increased rate of mortality.
Mortality Signals Halt Trial in France
In an intention-to-treat analysis of 535 patients, a major adverse kidney event by day 90 occurred in 78.1% of the intermittent group versus 71.6% of the continuous group, according to Stéphane Gaudry, MD, PhD, of Avicenne Hospital in Bobigny, France, and colleagues. The open-label trial’s data and safety monitoring board halted the study early after discovering a higher mortality signal in the intermittent arm.
By day 90, deaths occurred in 63.1% of the intermittent arm compared with 53.5% of the continuous arm. Kaplan-Meier mortality estimates suggested a 30% higher risk of death with the intermittent approach, with a hazard ratio of 1.30 and a 95% CI of 1.04 to 1.63.
Unexpected Clinical Outcomes Spark Debate
Researchers called the higher mortality in the intermittent hemodialysis group “unexpected” based on prior literature and “not readily explained.” Post hoc analyses suggested greater hemodynamic stress with intermittent hemodialysis, though the research team noted these exploratory findings are hypothesis generating and do not establish a causal mechanism.
An accompanying editorial by Paul Palevsky, MD, of the Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Medicine noted that previous trials of small-to-moderate scale largely found no survival differences. Palevsky noted that while intermittent hemodialysis corrects fluid and electrolyte imbalances rapidly, it “can result in rapid fluid and electrolyte shifts that may contribute to hemodynamic instability.”
Multicenter Trial Design and Patient Demographics
Originally planned for 1,000 patients, the multicenter trial enrolled 554 participants across intensive care units in France between October 2023 and July 2025. Medical admissions to the ICU outnumbered surgical ones for the majority of participants, roughly half had acute respiratory distress syndrome initially, and upwards of 70% were undergoing invasive mechanical ventilation when they entered the ICU.
Common coexisting conditions among study participants included hypertension (50%), type 2 diabetes (28%), chronic kidney disease (19%), and congestive heart failure (11%). Patients in the intermittent group required renal-replacement therapy for a median duration of 5 days, compared to 7 days for the continuous group, with hypotension serving as the most frequent complication in both treatment arms.