Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury

Key numbers

• 25% above the baseline value
• 95% confidence interval
• 63.3% and 53.6%

Background The preferred method of renal-replacement therapy for acute kidney injury in critically ill patients remains uncertain. Methods In this multicenter, open-label, noninferiority trial, we randomly assigned critically ill adults with acute kidney injury who had indications for renal-replacement therapy to undergo intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. The primary outcome was a major adverse kidney event - defined as death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value - by day 90. Results The trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy. A total of 554 patients underwent randomization, with 272 patients assigned to undergo intermittent hemodialysis and 282 to undergo continuous renal-replacement therapy; 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population. A major adverse kidney event occurred by day 90 in 203 patients (78.1%) in the intermittent group and in 197 patients (71.6%) in the continuous group (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval [CI], -1.22 to 13.79). Death by day 90 occurred in 164 patients (63.1%) and in 147 patients (53.5%), respectively. Kaplan-Meier mortality estimates at day 90 were 63.3% and 53.6% (hazard ratio, 1.30; 95% CI, 1.04 to 1.63). The most common complication potentially related to acute kidney injury or renal-replacement therapy was hypotension, which occurred in 179 patients (68.8%) in the intermittent group and in 183 patients (66.5%) in the continuous group. Conclusions Among critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.).

Stéphane Gaudry, Marouane Boubaya, Guillaume Louis, Khalil Chaïbi, Etienne de Montmollin, Julien Bohé, Maxime Desgrouas, Clément Devautour, Adrien Joseph, Bruno Mégarbane, Christophe Camus, Pierre Bailly, Alexis Lambour, Romain Arrestier, Samir Jaber, Adrien Robine, Nicolas Chudeau, Guillaume Chevrel, Béatrice La Combe, Jonathan Nicolas, Laurent Argaud, Côme Bureau, Antoine Kimmoun, Noémie Zucman, Jean-Damien Ricard, Guillaume Thiery, Stanislas Faguer, Mathieu Jozwiak, Nathan Ferrand, Benjamin Chousterman, et al.

Leverage2 / 5

Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).

10% of this desk’s rubric

Magnitude3 / 5

Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.

20% of this desk’s rubric

Evidence4 / 5

Strong: large scale, preregistered, independently replicated, or a well-powered randomized trial.

32% of this desk’s rubric

Novelty3 / 5

A genuinely new approach to an open problem.

8% of this desk’s rubric

Trajectory2 / 5

Some room to improve with obvious engineering.

5% of this desk’s rubric

Stakes3 / 5

Meaningful benefit to many people within a few years.

25% of this desk’s rubric

• Citations1 (reference 20, via openalex, Oct 20, 2026, 06:17 UTC)

• Reviewed by heuristic-v7 on Oct 20, 2026, 06:17 UTC. Paper type: clinical.
• Categories: Journal Article
• BRIEF, No.3 in the Medicine edition of October 20, 2026.