MEDIA RELEASE
EMBARGO: 8AM AEDT, THURSDAY 22 OCTOBER
New intensive care study set to change clinical practice: study confirms
aggressive kidney treatments not justified
New research released today will have significant impact on the treatment of kidney failure patients in
intensive care settings around the world. The largest study of its kind has shown that aggressive continuous
renal-replacement therapy, a type of dialysis designed to treat severe kidney failure in acutely ill patients in
intensive care units (ICUs), does not improve the chances of survival. The research conducted in Australian
and New Zealand reveals that lower-intensity dialysis is just as effective.
Severe acute kidney injury requiring dialysis to replace kidney function affects around 5% of patients admitted
to the ICU and results in death for about 50% of patients. Continuous renal-replacement treatment replaces
lost kidney function for people with acute kidney failure. To date, the optimal intensity of therapy has been
unclear, but due to this new large study, researchers have confirmed that there is no difference between
higher and lower-intensity treatments.
“We assessed 1508 critically ill adults with acute kidney injury, 747 were randomly assigned a higher-intensity
therapy, and 761 to lower-intensity therapy. There were no benefits seen among patients assigned to a
higher-intensity program of dialysis. In countries where continuous renal-replacement therapy is now the
preferred form of renal-replacement therapy in the ICU, our study has significant implications for clinical
practice”, said, Professor Alan Cass, The George Institute.
Researchers set out to see if the higher-intensity treatment (40ml per kilogram of body weight per hour)
compared to a lower-intensity treatment (25ml per kilogram of body weight per hour) would reduce mortality
within 90 days of presenting to intensive care settings. Patients presented to the ICU with acute kidney failure
due to a range of causes including severe infection, complications after major surgery or illness, with
cardiovascular disease or surgery being the common precipitating factor, and trauma.
“Notably, this study found no significant benefit of high-intensity treatment for acute kidney injury patients,
and there was also no evidence of significant harm. Importantly, survivors from both groups had a very low
rate of dependence of ongoing dialysis at 90 days, which is extremely positive. We intend on following these
patients in the future to assess their ongoing quality of life to show the impact these treatments could have on
resources and broader hospital management”, said Professor Rinaldo Bellomo, Australian and New Zealand
Intensive Care Society.
“The results of the this landmark study also confirm that the use of low-intensity renal replacement therapy is
associated with substantial cost savings in critically ill patients without compromising survival or rate of
recovery of kidney failure”, Professor Bellomo added.
The RENAL (Randomised Evaluation of Normal versus Augmented Level) Replacement Therapy Study is a
multicentre, randomised controlled trial and is a collaboration of the Australian and New Zealand Intensive
Care Society Clinical Trials Group (ANZICS CTG) and The George Institute for International Health. The
study was conducted in 35 intensive care units in Australia and New Zealand. This study was supported by
grants from the National Health and Medical Research Council of Australia and the Health Research Council
of New Zealand.
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For further information, please contact:
Angela Byrnes, The George Institute for International Health
Mobile: +61410 411 983
Fax: +612 9993 4501/ email: abyrnes@george.org.au
The George Institute is a world renowned health and medical research institute, focused on the prevention
and management of chronic disease and injury. The George is affiliated with the University of Sydney and
conducts high-impact research across a broad health landscape and is a respected voice among global
policy makers. The George has conducted major global applied research projects and innovative community-
based programs from bases in Australia, China and India. In 2009, the Institute celebrates a decade of
The Australian and New Zealand Intensive Care Society (ANZICS) is the peak professional and advocacy
body for medical practitioners specialising in the treatment and management of critically ill patients in public
and private hospitals. It has one of the largest repositories of intensive care clinical and resource data in the
world. World leaders in intensive care research through Clinical Trials Group and patient databases, the
Society is devoted to all aspects of intensive care medical practice through ongoing professional education,
provision of leadership in medical settings, clinical research and analysis of critical care resources.
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