Navigation Links
Intensive Dialysis Doesn't Save Lives of the Sickest
Date:10/21/2009

Study finds no difference when compared to routine dialysis

WEDNESDAY, Oct. 21 (HealthDay News) -- Giving seriously ill patients high-intensity dialysis is no better at saving lives or speeding recovery than a lower-intensity version of the same treatment, new research shows.

The patients in question were the sickest of the sick; all were in hospital intensive care units (ICUs).

"Approximately half had overwhelming infection, causing multiple body organs to fail. Others had complications following major surgery, most commonly for heart surgery, and some were admitted to ICU following severe trauma or injury," explained Dr. Alan Cass, co-author of the study published in the Oct. 22 issue of the New England Journal of Medicine.

"Findings from previous, smaller studies had suggested that intensive dialysis treatment for people with severe acute kidney injury saved lives," said Cass, director of the renal and metabolic division at the George Institute for International Health in Sydney, Australia. "This study, consistent with the findings of another recent large trial, found no benefit with intensive dialysis over standard dialysis treatment. No benefit was seen in terms of reduction in deaths or length of time in hospital, nor was there any difference in the need for ongoing and costly dialysis support."

"The two doses they chose -- so-called standard or a higher dose -- really didn't make any difference in outcome and that clarifies previous papers, some of which said the more you gave the better," added Dr. Kevin Martin, chief of nephrology at Saint Louis University School of Medicine.

According to background information in the paper, about 5 percent of patients in hospital ICUs have kidney injury severe enough to warrant dialysis. Of these, 60 percent will die.

But it's been unclear which dialysis approach is best.

For this study, 1,508 acutely ill patients were randomized to receive either a high-intensity or low-intensity version of continuous renal-replacement therapy.

"About three-quarters [of patients] were on ventilators, and most also needed continuous medication to support their heart and blood pressure, in addition to needing dialysis to simply stay alive," Cass said.

Continuous dialysis filters more slowly than intermittent dialysis, which is performed once every other day or every three days.

After 90 days, the mortality rate in the two groups was the same: 44.7 percent. The authors discerned no major differences in how long patients had to stay on dialysis, in rates of organ failure, need for mechanical ventilation or length of stay in either the ICU or the hospital.

The authors stressed, however, that a certain threshold of intensity did need to be reached to see any benefit. It's just that anything beyond this threshold is unlikely to bring any added value.

"A higher-dose therapy probably doesn't really change anything and there is probably no need to go that far or to that expense. It doesn't change the outcome," Martin said.

Although Cass predicted the results would "strongly influence current practice," that likely depends on geography, as different areas of the world use different standard treatments now.

A second study in the same issue of the journal found that intensive control of blood pressure using an ACE inhibitor improved kidney function in children aged 3 to 18 with chronic kidney disease.

Even though the decrease in blood pressure was considered "modest," the authors stated that "the progression of renal disease was significantly delayed."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on dialysis.



SOURCES: Alan Cass, M.D., Ph.D., director, renal and metabolic division, George Institute for International Health, Sydney, Australia; Kevin Martin, M.D., chief, division of nephrology, Saint Louis University School of Medicine; Oct. 22, 2009, New England Journal of Medicine


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Intensive care units poorly equipped to care for the dying
2. University Medical Center Mainz Completes Installation of Masimo Noninvasive and Continuous Hemoglobin Throughout Their Operating Rooms, Intensive Care Units and Emergency Department
3. Integrated Medical Systems Receives CE Mark for Worlds First Suitcase Intensive Care Unit
4. The Breema Center Presents Its Fall Week-Long Intensive on Giving and Receiving Breema Bodywork
5. Integrated Medical Systems Receives $1.1 Million From the U.S. Department of Defense for Critical Enhancements of the Worlds First Suitcase Intensive Care Unit
6. Integrated Medical Systems Receives $3.25 Million from the U.S. Army for Worlds First Suitcase Intensive Care Unit
7. Integrated Medical Systems Ships Worlds First Suitcase Intensive Care Unit to U.S. Army
8. Innovator's Studio offers Social Media Strategy Intensive Sept 16-17, 2009
9. Intensive management can improve blood pressure in non-adherent hypertensive patients
10. New findings encourage more vigilant monitoring of seizure activity among intensive care patients
11. BioFit Intensive Plus™ Chairs Meet Federal Standard for Continuous Intensive Use
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... CA (PRWEB) , ... February 12, 2016 , ... As ... a hectic schedule, a demanding job, and no time to decompress, Rabinowitz found herself ... dedicated herself to meditation for its impact on her life, implementing a 20-minute-per-day meditation ...
(Date:2/12/2016)... ... February 12, 2016 , ... The ThedaCare Center ... Francisco General Hospital on April 5-7. The series is a multi-day, multi-workshop event ... The workshops cover a broad range of topics, including coaching skills, the scientific ...
(Date:2/12/2016)... ... February 12, 2016 , ... Fisher House Foundation Chairman and CEO Kenneth Fisher ... Military Support Alliance president Scott Bensing, and Peggy Kearns Director, VA Southern Nevada Healthcare ... System. This will be the first Fisher House in Nevada, and will provide ...
(Date:2/12/2016)... ... ... Vail knee specialist Robert LaPrade, MD, PhD was named one of ... of physicians establishing, leading and partnering with ambulatory surgery centers across the United States. ... also known as an ASC, is a modern health care facility focused on providing ...
(Date:2/12/2016)... , ... February 12, 2016 , ... Donor Network West, ... California and Nevada, announced a partnership with San Ramon Regional Medical Center. Under the ... hospital’s facilities as a way to accommodate a more certain time frame for donor ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... -- The primary goal of this research is to ... usage of liquid biopsy. Key information the survey seeks ... of liquid biopsy adoption amidst future users - Predominantly ... - Sample inflow to conduct liquid biopsy tests - ... so on. - Correlation analysis of sample type and ...
(Date:2/11/2016)... NEW YORK , Feb. 11, 2016 ... and instruments commonly used in laboratories. These may range ... scale condensers. Laboratory glassware is made from borosilicate glass ... shock. Laboratory plasticware, on the other hand, started gaining ... that it was easier to replace glass with plastic ...
(Date:2/11/2016)... , Feb. 11, 2016  Governor Andrew M. ... will create 1,400 jobs throughout Western New ... partnership with the SUNY Polytechnic Institute, includes a major ... Building in Buffalo , as well ... manufacturing facility in Dunkirk . The ...
Breaking Medicine Technology: