Intensive versus Conventional Renal Support in Acute Renal Failure

INTERVENTION: Intensive renal replacement therapy defined as: Daily (except Sunday) intermittent hemodialysis when hemodynamically stable and Continuous venovenous hemodiafiltration at 35 mL/kg per hour or daily (except Sunday) sustained low‐efficiency dialysis when hemodynamically unstable Duration of intervention: Up to 28 days or until recovery of kidney function, withdrawal of life support, death or discharge from acute care CONDITION: Acute Renal Failure PRIMARY OUTCOME: All‐cause mortality as assessed from medical records SECONDARY OUTCOME: All‐cause in‐hosptial mortality assessed from hospital medical records All‐cause mortality assessed from follow‐up telephone interview and/or vital status registry Recovery of renal function defined as a measured creatinine clearance of > 20 mL/min INCLUSION CRITERIA: 1. Acute renal failure (ARF) clinically consistent with a diagnosis of acute tubular necrosis (ATN), defined as: clinical setting of acute ischemic or nephrotoxic injury; and oliguria (average urine output < 20 mL/hr) for > 24 hours or an increase in serum creatinine of at least 2.0 mg/dL (men)/1.5 mg/dL (women) over a period of no more than 4 days 2. Plan for renal replacement therapy 3. Receiving care in critical care unit 4. At least one non‐renal organ failure (Sequential Organ Function Assessment organ system score of at least 2) or the presence of sepsis 5. Age of at least 18 years 6. Informed consent