Sensible Medicine This Fortnight in Medicine XIX
Feb 11, 2026
They debate a trial that tested scheduled versus as‑needed dialysis for acute kidney injury and question how enrollment and ICU focus affect results. They examine a patient‑level meta‑analysis on beta blockers after heart attack in people with normal pumping function. They argue about whether older evidence still applies and the practical tradeoffs of using less treatment.
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Conservative Dialysis Shows Suggestive Benefit
- Conservative "as-needed" dialysis trended toward more kidney recovery at discharge than scheduled dialysis in LIBERATE‑D.
- The adjusted result was not statistically significant, so the trial is effectively negative but suggestive.
High Screen‑Fail Rate Limits Generalizability
- LIBERATE‑D screened 909 patients but enrolled only 220, reflecting strong selection and limited generalizability.
- High exclusion rate (many clinician/patient declines) suggests entrenched practice patterns favoring scheduled dialysis.
Favor Less Routine Dialysis When Safe
- Prefer a conservative dialysis approach when patients clearly don't require routine sessions, because less dialysis reduces harms like intradialytic hypotension.
- Use clinical judgment and local dialysis expertise to decide when scheduled trips can be safely deferred.