ATN Study: More Is Not Better

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The results from the Acute Renal Failure Trial Network (“ATN Study“) are revealed in the most recent issue of the New England Journal of Medicine.

The study was a randomized control trial in which ICU patients with acute kidney injury were randomly selected to receive either standard-dosed dialysis (defined as three times a week hemodialysis or CVVH at 20 cc/kg/hr) or more intensively-dosed dialysis (defined as six times a week hemodialysis or CVVH at 35 cc/kg/hr). The trial was not, as some people erroneously believe, intended to settle the contentious issues of whether there is any benefit of CVVH over intermittent hemodialysis; patients were actually permitted to move back and forth between intermittent hemodialysis and CVVH provided they stayed within the intensive versus the standard group to which they were originally assigned.
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The results: no significant difference was found in the standard compared to the intensively-dosed groups. The study is somewhat at odds to the famous Ronco study published in 2000 in the Lancet which demonstrated a survival benefit in patients who received a higher dose of CVVH (either 35 or 45 cc/kg/hr) compared to those receiving a lower dose (25cc/kg/hr).

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