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Multi-Center Study to Focus on Critically Ill Patients with Acute Kidney Failure

WINSTON-SALEM, N.C. – Researchers at Wake Forest University Baptist Medical Center and 30 other centers are exploring better ways to treat acute kidney failure, a complication that most often occurs in critically ill patients.

If the kidneys abruptly fail and can no longer excrete fluid and other waste products, patients require kidney dialysis, said Michael Rocco, M.D., professor of internal medicine - nephrology.

A three-year clinical trial will enroll intensive care patients with acute kidney failure to determine if a higher intensity of dialysis treatments will result in improved outcomes.

Patients in the intensive care unit who have normal blood pressure will be randomly assigned either to the standard method of kidney dialysis treatment -- three times a week, or to a higher intensity method with dialysis six times a week. All sessions last three to five hours.

Patients with low blood pressure who are too unstable for the standard dialysis treatment will receive a slow, continuous form of dialysis and will be assigned to receive one of two dose intensities. The dialysis dose is the rate at which blood and dialysis fluids flow through the dialysis machine.

More than 1,200 patients will participate in the trial nationwide, Rocco said.

“Despite all the improvements that have been made in the care of patients in the intensive care unit (ICU), the death rate for ICU patients who develop acute kidney failure is 30 percent to 50 percent and has remained unchanged for the past 30 years,” said Rocco, principal investigator for the study at Wake Forest Baptist. “This study will help to determine if a more intensive dialysis schedule will decrease this high death rate.”

Rocco attributes the lack of improvement in the death rate in part to the increasing severity of illness of patients in intensive care units.

“New medical technologies today keep patients with serious medical conditions alive,” he said. “In many cases, these technologies did not exist 20 to 30 years ago. So, despite the many advances that have occurred with dialysis treatments in the intensive care unit, we need to work even harder to develop strategies to allow more patients to survive an episode of acute kidney failure.”

Numerous studies have been conducted aimed at improving the death rate for patients with acute kidney failure, with very limited success.

Elizabeth Deterding, M.D., assistant professor of internal medicine - nephrology will be a coinvestigator at Wake Forest Baptist.

The national study is funded by both the Department of Veterans Affairs (VA) and the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health. More than 30 centers throughout the United States will be participating in this trial, including more than 20 VA hospitals.

Wake Forest Baptist, one of nine non-VA sites in the study, is being funded by a $730,000 grant from the Veterans Administration. Enrollment of patients at Wake Forest Baptist will begin in March.


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