Continuous venovenous hemodiafiltration and intermittent hemodialysis did not differ for improving survival in ARF with multiorgan dysfunction.

M e t h o d s Design: Randomized controlled trial. Allocation: Concealed.* Blinding: Blinded (outcome assessors).* Follow-up period: Up to 90 days. Setting: 21 intensive care units (ICUs) in university or community hospitals in France. Patients: 360 patients (mean age 65 y, 73% men) who had ARF, the multiple-organ dysfunction syndrome, and need for renalreplacement therapy. Exclusion criteria included chronic renal failure, ARF of obstructive or vascular origin, continuing treatment with an angiotensin-converting enzyme inhibitor, coagulation disorders, uncontrolled hemorrhage, simplified acute physiology score II ≤ 37, moribund state, and survival expectancy < 8 days. Intervention: CVVDHF (n = 176) or IHD (n = 184). In CVVDHF, the metabolic objective was to maintain the urea level < 30 mmol/L. The recommended initial settings were blood flow ≥ 120 mL/min, dialysate flow ≥ 500 mL/h, and ultrafiltration flow ≥ 1000 mL/h. A change of membrane every 48 hours was also recommended. In IHD, the objective was a urea reduction ratio > 65% for each session. The recommended initial settings were blood flow ≥ 250 mL/min and dialysate flow ≥ 500 mL/h. Also recommended were a high sodium level (150 mmol/L) and a low temperature (35 °C). All patients received unfractionated or low-molecular-weight heparin. Outcomes: 60-day survival. Secondary outcomes included 28and 90-day survival, ICU and hospital lengths of stay, duration of extrarenal support, and adverse events. Patient follow-up: 99.7% (intention-to-treat analysis).