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News
A major clinical trial was stopped early after finding that critically ill patients with acute kidney injury (AKI) on intermittent hemodialysis faced a 30% higher risk of death compared to those on continuous renal replacement therapy (CRRT). The ICRAKI trial, published in the New England Journal of Medicine, now supports CRRT as the preferred initial approach for severe AKI in the ICU.
A landmark clinical trial has upended longstanding assumptions about kidney replacement therapy in the ICU. The ICRAKI trial, published in The New England Journal of Medicine, was stopped early after data revealed that critically ill patients with acute kidney injury (AKI) on intermittent hemodialysis had a significantly higher risk of death compared to those receiving continuous renal replacement therapy (CRRT). The trial enrolled over 500 patients across 42 ICUs in France between 2023 and 2025.
Researchers had expected any differences to center on kidney recovery outcomes — not mortality. But the mortality signal was striking enough to halt the trial ahead of schedule, shifting the clinical conversation considerably.
By the Numbers:
Why it matters: For ICU clinicians managing severe AKI, this trial provides the clearest evidence yet that CRRT should be the go-to initial modality — even in patients who aren't the most hemodynamically unstable. Future research will focus on when it's safe to transition patients from CRRT to intermittent hemodialysis during recovery.
