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Intensity of renal replacement therapy in acute kidney injury: perspective from within the Acute Renal Failure Trial Network Study

Paul M Palevsky12*, Theresa Z O'Connor3, Glenn M Chertow4, Susan T Crowley35, Jane Hongyuan Zhang3, John A Kellum2 and the US Department of Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network

Author Affiliations

1 Room 7E123 (111F-U), VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240, USA

2 University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA

3 VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA

4 Stanford University School of Medicine, Palo Alto, CA 94305, USA

5 Yale University School of Medicine, New Haven, CT 06520, USA

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Critical Care 2009, 13:310  doi:10.1186/cc7901

Published: 11 August 2009

Abstract

Determination of the optimal dose of renal replacement therapy in critically ill patients with acute kidney injury has been controversial. Questions have recently been raised regarding the design and execution of the US Department of Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network (ATN) Study, which demonstrated no improvement in 60-day all-cause mortality with more intensive management of renal replacement therapy. In the present article we present our rationale for these aspects of the design and conduct of the study, including our use of both intermittent and continuous modalities of renal support, our approach to initiation of study therapy and the volume management during study therapy. In addition, the article presents data on hypotension during therapy and recovery of kidney function in the perspective of other studies of renal support in acute kidney injury. Finally, we address the implications of the ATN Study results for clinical practice from the perspective of the study investigators.