High Dose CVVHDF Compared to Standard Dose CVVHDF

Phase 3

Completed

Interventions: Device: Standard dose of dialysis
Device: High dose of dialysis

Brief Summary: In the last three decades, the mortality associated with acute renal failure (ARF) in the ICU has remained unchanged at greater than 50%, despite improvements in dialysis technology.

The primary objective is to determine whether Continuous Veno-Venous Hemodiafiltration (CVVHDF) using an ultrafiltration rate of 35 ml/hr/kg (high dose) leads to a greater reduction in all-cause ICU mortality compared to standard CVVHDF using an ultrafiltration rate of 20 ml/hr/kg.

Detailed Description: Although the worldwide standard for renal replacement therapy is intermittent hemodialysis(IHD), continuous renal replacement therapy (CRRT) has emerged as an alternative form of renal replacement therapy in the critical care setting due to its advantages of slow continuous fluid removal, steady acid-base correction, and hemodynamic stability.

There are no standard protocols for initiating or administering CRRT, and practice patterns vary widely among institutions, with less than 25% of patients with ARF in the ICU receiving this therapy in the United States.

Various CRRT modalities are available that use diffusion, convection, or a combination of both to obtain adequate solute clearance. However, there is no consensus as to the optimal dialysis modality, adequate dialysis dose, or optimal clearance modality (convection vs. diffusion). Clinical trials are needed to determine the optimal method of administering CRRT, with respect to modality, dose of dialysis, and time of initiation of therapy.

Although some studies suggest that a higher dose of dialysis improves survival, there have been no prospective randomized studies comparing the effectiveness of diffusion and convection, combined together, for solute clearance.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Patients with end stage renal disease
Patients who have had more than one previous dialysis session for acute or chronic renal failure during the current hospitalization
Patient weight greater than 125 kg
Patient weight less than 50 kg
Pregnancy
Prisoner
Non-candidacy for continuous renal replacement therapy (CRRT)
Patient/surrogate refusal

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
1	Standard dose of dialysis	Standard dose Continuous Venovenous Hemodiafiltration (CVVHDF) at an effluent rate of 20 ml/kg/hr
2	High dose of dialysis	High dose Continuous Venovenous Hemodiafiltration (CVVHDF) at an effluent rate of 35 ml/kg/hr

Primary Outcome Measures

Name	Time	Method
Number of Participants Alive at 30 Days After Enrollment Compared Between High Dose Versus Standard Dose Continuous Venovenous Hemodiafiltration (CVVHDF)	Up to 30 days	The primary objective is to determine whether Continuous Venovenous Hemodiafiltration (CVVHDF) using an effluent rate of 35 ml/hr/kg (high dose) leads to an increased participant survival time as compared to CVVHDF using the standard effluent rate of 25 ml/hr/kg as measured by days on continuous renal replacement therapy (CRRT) at enrollment up to 30 days.

Secondary Outcome Measures

Name	Time	Method
Recovery of Renal Function, Defined as Not Requiring Dialysis After Discontinuation of CRRT	Up to 30 days	The number of participants who recover renal function at 30 days after enrollment in each arm.