Intensive Dialysis Might Not Always Help
With acute kidney injury, more sessions may not improve results

(HealthDay News) -- When it comes to kidney dialysis for an acute kidney injury, more might not always be better.

Sometimes, often with serious infections, the kidneys suddenly stop working. As many as 2 to 7 percent of all hospitalized patients and 35 percent of those considered critically ill have this type of acute kidney injury. An estimated 50 to 80 percent of those who suffer an acute kidney injury will die.

But a report in the New England Journal of Medicine found that "increasing the dose of dialysis beyond what is considered normal did not improve outcomes," the lead author of the study, Dr. Paul M. Palevsky, a professor of medicine at the University of Pittsburgh , told HealthDay . "There was no improvement in survival, no improvement in recovery of renal function and no improvement in the course of non-renal organ failure. So, more was not better."

The kidneys perform a number of critical functions. The most well-known is to filter waste and excrete excess fluid from the body through urine. The kidneys also help filter toxins, such as drugs, and they maintain the body's fluid balance as well as keep salt, potassium and acid at their proper levels. The kidneys also release hormones that control blood pressure. And, they produce vitamin D. One of their most important functions, according to the National Kidney Foundation, is to control the production of red blood cells.

Each day the kidneys filter about 200 quarts of fluid.

When people suffer acute kidney injury because of other conditions, their kidney function usually returns once they have recovered from the original illness. While the kidneys aren't functioning, standard dialysis must be performed to prevent a build-up of toxins. Some research had suggested that additional dialysis might improve the outcome for these seriously ill people.

To see if this was truly the case, Palevsky and his colleagues recruited 1,124 people with an acute kidney injury. Half received standard dialysis, which is three days a week, and the other half were put on a more intensive dialysis regimen, which occurs six times weekly.

There was no difference in the length of time dialysis was needed, in the recovery of kidney function or in the rate at which other organs failed. There was a slight difference in the death rate -- about 54 percent of those on intensive dialysis died during the two-month study period, compared with 52 percent of those on standard therapy.

"In acute kidney injury, there is no specific treatment to reverse kidney function. The treatment is predominantly supportive," Palevsky said.

"The evidence suggests that doing it well, but not necessarily doing more of it, is what is best for patients," he noted.

Dr. Ajay K. Singh, clinical director of the renal division at Brigham and Women's Hospital and an associate professor of medicine at Harvard Medical School in Boston, told HealthDay that "based on this study, we will go back to adopting the less-intensive approach."

Singh added, "However, it is disappointing that we are unable to identify a therapeutic strategy that improves the survival of our patients with acute kidney injury. This study should further underscore the importance of developing novel strategies to improve outcomes in these patients."

On the Web

To learn more about kidney failure and treatment options, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: HealthDay News ; Paul M. Palevsky, M.D., professor of medicine, University of Pittsburgh, Pittsburgh, Pa.; Ajay K. Singh, M.D., clinical director, Renal Division, Brigham and Women's Hospital, and associate professor of medicine, Harvard Medical School, Boston; July 3, 2008, New England Journal of Medicine ; National Kidney Foundation (www.kidney.org)
Author: Serena Gordon
Publication Date: May 31, 2009
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