The “French Hemodiafe Trial”: This Study is Neither Decisive nor Definitive in Resolving the Controversy on Renal Replacement Therapy in ICU

Abstract

This short review paper addresses a recently published study on the controversy concerning the type of renal replacement therapy (RRT) used in ICU. It proposes a somewhat different point of view regarding this study, based on the numerous problems that have been identified with it. Indeed, given these shortcomings, the study conclusions are somewhat misleading and are not effectively supported by the trial data. If the treatment doses were comparable and kept constant in the “IHD” group, then the results may well have been strikingly different. In keeping with all drugs used in medicine, dose is crucial and should have remained unchanged by the investigators during the study in order to be able to draw valid conclusions based on the evidence. There is a need for a further study comparing CRRT and IHD. This should be better designed in terms of the exclusion criteria, delivered dose of CVVH (35 ml/kg/h) and IHD, timing of treatment and should also examine more secondary endpoints. This may answer many of the outstanding issues and provide a balanced opinion about this study and its real importance in ICU practice. Finally, this study does not have the scientific power (as explained by the accompanying editorial by Kellum) to put an end to the ICU controversy regarding the choice of RRT in acute renal failure while in ICU. Therefore, there is an urgent need for a better designed study regarding this controversy.