Tuesday, May 20, 2008

ATN Study: More Is Not Better

The results from the Acute Renal Failure Trial Network ("ATN Study") are revealed in the most recent issue of the New England Journal of Medicine.

The study was a randomized control trial in which ICU patients with acute kidney injury were randomly selected to receive either standard-dosed dialysis (defined as three times a week hemodialysis or CVVH at 20 cc/kg/hr) or more intensively-dosed dialysis (defined as six times a week hemodialysis or CVVH at 35 cc/kg/hr). The trial was not, as some people erroneously believe, intended to settle the contentious issues of whether there is any benefit of CVVH over intermittent hemodialysis; patients were actually permitted to move back and forth between intermittent hemodialysis and CVVH provided they stayed within the intensive versus the standard group to which they were originally assigned.
The results: no significant difference was found in the standard compared to the intensively-dosed groups. The study is somewhat at odds to the famous Ronco study published in 2000 in the Lancet which demonstrated a survival benefit in patients who received a higher dose of CVVH (either 35 or 45 cc/kg/hr) compared to those receiving a lower dose (25cc/kg/hr).

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