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BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a694 (Published 07 July 2008) Cite this as: BMJ 2008;337:a694

Intensive dialysis fails to improve survival after acute kidney injury

Many critically ill people develop acute renal failure and need dialysis. The optimum timing, dose, and duration isn’t yet clear, but a recent large trial suggests that more isn’t necessarily better. The researchers compared intensive and less intensive regimens in 1124 critically ill patients with acute kidney injury and failure of at least one other organ system or sepsis. Just over half of each group died within 60 days (53.6% (302/563) of the intensively treated group v 51.5% (289/561) of the less intensively treated group, odds ratio 1.09, 95% CI 0.86 to 1.4). More dialysis did not result in faster recovery of renal function or any other organ system. About one in six participants made it home without needing dialysis by day 60. Again the groups did not differ (15.7% (88/560) v 16.4% (92/561); P=0.75). These results may not apply to women. Three quarters of the participants were men.

Intensively treated participants had haemodialysis six days a week. Those who were haemodynamically unstable had low efficiency dialysis six times a week or continuous venovenous haemodiafiltration at a flow rate of 35 ml/kg/hour. Controls had a treatment regimen comparable to usual care—haemodialysis or low efficiency dialysis three times a week, or haemodiafiltration at a flow rate of 20 ml/kg/hour.

Follow guidelines on salmeterol, even if combined with an inhaled corticosteroid

Long acting β agonists such as salmeterol have been linked to increased risk of asthma exacerbations and even asthma related deaths. Do these safety concerns extend to people who also use an inhaled corticosteroid? One expert (p 56) warns doctors to be cautious with combination treatments too, despite an apparently reassuring meta-analysis of 66 industry sponsored trials. People given salmeterol and an inhaled steroid were no more likely to be admitted to hospital with asthma than those using an inhaled steroid alone (35 v 34 asthma related hospital admissions, P=0.84), …

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