Design and challenges of the Randomized Evaluation of Normal versus Augmented Level Replacement Therapy (RENAL) Trial: High-dose versus standard-dose hemofiltration in acute renal failure

Rinaldo Bellomo, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Donna Goldsmith, John Myburgh, Robyn Norton, Carlos Scheinkestel, Ashoke Banarjee, Deepk Bhonagiri, David Blythe, John Botha, John Cade, Geoff Dobb, John Eddington, Arthas Flabouris, Craig French, Peter Garrett, Seton HendersonBenno Ihle, Chris Joyce, Michael Kalkoff, Jeff Lipman, Colin McArthur, Shay McGinness, David Milliss, Imogen Mitchell, John Morgan, Priya Nair, Neil Orford, Asif Raza, Yahya Shehabi, Antony Tobin, Richard Totaro, Andrew Turner, Christopher Wright

Research output: Contribution to journalReview ArticleResearchpeer-review

22 Citations (Scopus)


Background/Aims: The optimal dose of renal replacement therapy (RRT) in acute renal failure (ARF) is uncertain. Methods: The Randomized Evaluation of Normal versus Augmented Level Replacement Therapy Trial tests the hypothesis that higher dose continuous veno-venous hemodiafiltration (CVVHDF) at an effluent rate of 40 ml/kg/h will increase survival compared to CVVHDF at 25 ml/kg/h of effluent dose. Results: This trial is currently randomizing critically ill patients in 35 intensive care units in Australia and New Zealand with a planned sample size of 1,500 patients. This trial will be the largest trial ever conducted on acute blood purification in critically ill patients. Conclusion: A trial of this magnitude and with demanding technical requirements poses design difficulties and challenges in the logistics, conduct, data collection, data analysis and monitoring. Our report will assist in the development of future trials of blood purification in intensive care. This study was registered with (NCT00221013).

Original languageEnglish
Pages (from-to)407-416
Number of pages10
JournalBlood Purification
Issue number5
Publication statusPublished - 1 Oct 2008


  • Acute renal failure
  • Continuous hemodiafiltration
  • Dialysis
  • Intensive care
  • Kidney
  • Renal replacement therapy, continuous

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