Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury
In brief
Intermittent dialysis had 10-point higher 90-day mortality than continuous therapy
In this randomized trial of critically ill adults with acute kidney injury, 90-day mortality was 63% with intermittent hemodialysis versus 54% with continuous therapy. The trial stopped early after a sustained mortality signal, and intermittent treatment was not shown to be noninferior for major kidney events; early stopping leaves uncertainty about the size of the difference.
- Journal
- The New England journal of medicine (Q1)
- Published
- 14 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Stéphane Gaudry, Marouane Boubaya, Guillaume Louis, Khalil Chaïbi, Etienne de Montmollin, Julien Bohé, et al.
- PMID
- 42873070
- DOI
- 10.1056/NEJMoa2608397
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 15 October 2026): Intermittent vs continuous RRT, mortality difference
Abstract
BACKGROUND: The preferred method of renal-replacement therapy for acute kidney injury in critically ill patients remains uncertain. METHODS: In 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. RESULTS: The 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. CONCLUSIONS: Among 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.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.