Intermittent Hemodialysis Falls Short of Continuous Therapy in Critically Ill AKI TrialTrial shows continuous renal-replacement therapy may reduce kidney injury mortality

The New England journal of medicine Published October 29, 2026 Study authors: Gaudry Stéphane, Boubaya Marouane, Louis Guillaume, Chaïbi Khalil, de Montmollin Etienne, Bohé Julie… PubMed ↗ NCT06032884 ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Intermittent hemodialysis was not noninferior to continuous therapy in critically ill AKI and showed higher 90-day mortality.

This multicenter randomized controlled trial enrolled 554 critically ill adults with acute kidney injury who had indications for renal-replacement therapy. Participants were assigned to intermittent hemodialysis or continuous renal-replacement therapy, with follow-up to day 90.

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 baseline. This composite occurred in 78.1% of the intermittent group versus 71.6% of the continuous group, a difference of 6.28 percentage points (95% CI, -1.22 to 13.79). The trial therefore did not demonstrate noninferiority of intermittent hemodialysis.

Mortality by day 90 was higher with intermittent hemodialysis: 63.1% versus 53.5%, with a hazard ratio of 1.30 (95% CI, 1.04 to 1.63). Absolute deaths were 164 in the intermittent group and 147 in the continuous group. Hypotension was reported as an adverse event; serious adverse events, discontinuations, and tolerability were not reported.

The trial was stopped early because of a sustained signal of higher mortality in the intermittent hemodialysis group, which limits interpretation of the effect estimates. Funding came from the French Ministry of Health.

For clinicians, these findings do not support substituting intermittent hemodialysis for continuous renal-replacement therapy in this population. The mortality difference is an association within a trial stopped early, and the results should not be read as proving that intermittent hemodialysis causes harm.

Researchers conducted a multicenter trial involving 554 critically ill adults with acute kidney injury who required renal-replacement therapy. The study compared two methods: intermittent hemodialysis and continuous renal-replacement therapy. The goal was to see which method better prevented major adverse kidney events, such as death or a significant rise in creatinine levels, over a 90-day period.

The results showed that patients receiving intermittent hemodialysis had a higher rate of major adverse kidney events (78.1%) compared to those receiving continuous therapy (71.6%). Additionally, the mortality rate was higher in the intermittent group, with 63.1% of patients dying by day 90 compared to 53.5% in the continuous group. Because of these findings, the trial was stopped early.

While the study suggests a link between the type of therapy and patient outcomes, it is important to note that this was an observational finding of association rather than proven cause. The study also noted that intermittent hemodialysis was not shown to be noninferior to continuous therapy. Patients and doctors should discuss these specific treatment options and their risks with a medical team.

What this means for you:

Continuous renal-replacement therapy was associated with lower mortality rates than intermittent hemodialysis.

Common questions

What is the difference between intermittent and continuous renal-replacement therapy?

Intermittent hemodialysis is performed in intervals, while continuous renal-replacement therapy is provided steadily. This trial of 554 patients found that the continuous method was associated with lower mortality rates (53.5%) compared to the intermittent method (63.1%) over a 90-day period.

Was the study successful in finding a better treatment?

The trial was stopped early because the data showed a higher mortality rate for patients receiving intermittent hemodialysis. The results showed that intermittent hemodialysis was not shown to be noninferior to continuous renal-replacement therapy for major adverse kidney events.

What were the specific risks found in the study?

The study noted that patients receiving intermittent hemodialysis had a higher rate of major adverse kidney events, which includes death, dependence on renal-replacement therapy, or high creatinine levels. These events occurred in 78.1% of the intermittent group compared to 71.6% of the continuous group.

Study Details

Study typeRct

Sample sizen = 554

EvidenceLevel 2

PublishedOct 2026

PMID42873070

TrialNCT06032884

View Original Abstract ↓

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.).

Intermittent Hemodialysis Falls Short of Continuous Therapy in Critically Ill AKI TrialTrial shows continuous renal-replacement therapy may reduce kidney injury mortality

Common questions

Study Details

Finerenone Efficacy and Safety in Patients with Chronic Kidney Disease and Glomerular Disease

Finerenone slows kidney function loss in patients with glomerular disease

Clinical research that matters. Delivered to your inbox.

Intermittent Hemodialysis Falls Short of Continuous Therapy in Critically Ill AKI TrialTrial shows continuous renal-replacement therapy may reduce kidney injury mortality

Common questions

More on Chronic Kidney Disease

Study Details

Finerenone Efficacy and Safety in Patients with Chronic Kidney Disease and Glomerular Disease

Finerenone slows kidney function loss in patients with glomerular disease

Clinical research that matters. Delivered to your inbox.

Related in Nephrology

From Other Specialties