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Higher Intensity Kidney Therapies Show Mixed Results

Intense renal-replacement not beneficial to adults, but blood-pressure control benefits kids

WEDNESDAY, Oct. 21 (HealthDay News) -- In critically ill adults with acute renal injury, higher-intensity renal-replacement therapy does not reduce mortality; however, in children with chronic kidney disease, higher-intensity blood-pressure control has beneficial effects on renal function, according to two studies in the Oct. 22 issue of the New England Journal of Medicine.

Rinaldo Bellomo, M.D., of Austin Hospital in Carlton, Australia, and colleagues randomly assigned 1,508 adults with acute renal injury to either higher-intensity therapy or lower-intensity renal-replacement therapy. After 90 days, they found that both groups had the same mortality rate (44.7 percent), and that 6.8 percent of survivors in the higher-intensity group and 4.4 percent of survivors in the lower-intensity group were still receiving renal-replacement therapy.

Elke Wühl, M.D., of the University of Heidelberg in Germany, and colleagues randomly assigned 385 children with chronic kidney disease to receive either intensified blood-pressure control or conventional blood-pressure control. After five years, they found that children in the intensified therapy group were significantly less likely to reach the primary end point: a 50 percent decline in the glomerular filtration rate or progression to end-stage renal disease (29.9 versus 41.7 percent).

"Failure to demonstrate improved outcomes with more intensive renal-replacement therapy in critically ill patients with acute kidney injury in both the RENAL study and the Acute Renal Failure Trial Network Study does not imply that the intensity of renal-replacement therapy does not matter," states the author of an accompanying editorial. "There is ample evidence of a relationship between the intensity of such therapy and outcomes."

Several authors from both studies and one editorial reported financial relationships with pharmaceutical and medical companies.

Abstract - Bellomo
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Abstract - Wühl
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