Continuous venovenous hemodiafiltration and intermittent hemodialysis did not differ for improving survival in acute renal failure with multiorgan dysfunction

摘要

CVVHDF offers more gradual fluid removal than IHD, a feature thatntheoretically might improve hemodynamic stability, but the cost ofnCVVHDF is much higher. The well-designed trial by Vinsonneau andncolleagues is notable for several reasons. First, CVVHDF did not leadnto a significant reduction in any of the clinical outcomes studied,nincluding number of days on dialysis or in hospital, or mortality at 90ndays. Although not statistically powered to conclusively exclude a clinicallynrelevant benefit, this trial is the largest and one of the best qualitynto examine this issue. Its findings add to a body of evidence indicatingnthat the dialysis modality alone is unlikely to influence outcomes in thisnpatient population. Supporters of CVVHDF cite such characteristics asnenhanced cytokine removal, but the clinical significance of this theoreticalnadvantage remains unknown.