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

mized 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
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