A randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients

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dc.contributor.authorPonce, Daniela [UNESP]
dc.contributor.authorBerbel, M. N. [UNESP]
dc.contributor.authorAbrão, Juliana Maria Gera [UNESP]
dc.contributor.authorGoes, C. R. [UNESP]
dc.contributor.authorBalbi, André Luis [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2014-05-27T11:29:34Z
dc.date.available2014-05-27T11:29:34Z
dc.date.issued2013-06-01
dc.description.abstractBackground: Acute kidney injury (AKI) requiring dialysis in critically ill patients is associated with an in-hospital mortality rate of 50-80 %. Extended daily hemodialysis (EHD) and high volume peritoneal dialysis (HVPD) have emerged as alternative modalities. Methods: A double-center, randomized, controlled trial was conducted comparing EHD versus HVPD for the treatment for AKI in the intensive care unit (ICU). Four hundred and seven patients were randomized and 143 patients were analyzed. Principal outcome measure was hospital mortality, and secondary end points were recovery of renal function and metabolic and fluid control. Results: There was no difference between the two groups in relation to median ICU stay [11 (5.7-20) vs. 9 (5.7-19)], recovery of kidney function (26.9 vs. 29.6 %, p = 0.11), need for chronic dialysis (9.7 vs. 6.5 %, p = 0.23), and hospital mortality (63.4 vs. 63.9 %, p = 0.94). The groups were different in metabolic and fluid control. Blood urea nitrogen (BUN), creatinine, and bicarbonate levels were stabilized faster in EHD group than in HVPD group. Delivered Kt/V and ultrafiltration were higher in EHD group. Despite randomization, there were significant differences between the groups in some covariates, including age, pre-dialysis BUN, and creatinine levels, biased in favor of the EHD. Using logistic regression to adjust for the imbalances in group assignment, the odds of death associated with HVPD was 1.4 (95 % CI 0.7-2.4, p = 0.19). A detailed investigation of the randomization process failed to explain the marked differences in patient assignment. Conclusions: Despite faster metabolic control and higher dialysis dose and ultrafiltration with EHD, this study provides no evidence of a survival benefit of EHD compared with HVPD. The limitations of this study were that the results were not presented according to the intention to treat and it did not control other supportive management strategies as nutrition support and timing of dialysis initiation that might influence outcomes in AKI. © 2012 Springer Science+Business Media Dordrecht.en
dc.description.affiliationUniversity São Paulo State (UNESP), Botucatu Sao Paulo
dc.description.affiliationUnespUniversity São Paulo State (UNESP), Botucatu Sao Paulo
dc.format.extent869-878
dc.identifierhttp://dx.doi.org/10.1007/s11255-012-0301-2
dc.identifier.citationInternational Urology and Nephrology, v. 45, n. 3, p. 869-878, 2013.
dc.identifier.doi10.1007/s11255-012-0301-2
dc.identifier.issn0301-1623
dc.identifier.issn1573-2584
dc.identifier.lattes5697804493071661
dc.identifier.scopus2-s2.0-84879489368
dc.identifier.urihttp://hdl.handle.net/11449/75492
dc.identifier.wosWOS:000320843400040
dc.language.isoeng
dc.relation.ispartofInternational Urology and Nephrology
dc.relation.ispartofjcr1.692
dc.relation.ispartofsjr0,653
dc.rights.accessRightsAcesso restrito
dc.sourceScopus
dc.subjectAcute kidney injury
dc.subjectExtended daily hemodialysis
dc.subjectMortality
dc.subjectPeritoneal dialysis
dc.subjectbicarbonate
dc.subjectcreatinine
dc.subjectnitrogen
dc.subjecturea
dc.subjectacute kidney failure
dc.subjectadult
dc.subjectage
dc.subjectaged
dc.subjectcontrolled study
dc.subjectdialysis equipment and supplies
dc.subjectextended daily dialysis
dc.subjectfemale
dc.subjecthemodialysis
dc.subjecthemodialysis machine
dc.subjecthigh volume peritoneal dialysis
dc.subjecthuman
dc.subjecthypervolemia
dc.subjectinfectious complication
dc.subjectintensive care
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmetabolic regulation
dc.subjectmortality
dc.subjectoliguria
dc.subjectperitoneal dialysis
dc.subjectrandomized controlled trial
dc.subjectultrafiltration
dc.subjecturea nitrogen blood level
dc.subjecturemia
dc.titleA randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patientsen
dc.typeArtigo
dcterms.licensehttp://www.springer.com/open+access/authors+rights
unesp.author.lattes5697804493071661[5]
unesp.author.orcid0000-0001-8366-5064[5]
unesp.author.orcid0000-0003-1166-637X[4]
unesp.author.orcid0000-0002-6178-6938[1]
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt

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