Continuous renal replacement therapy. The real story

Continuous renal replacement therapy (CRRT) is used to treat patients who suffer from acute renal failure. Unlike the more traditional intermittent hemodialysis (IHD), CRRT is administered around the clock, providing patients with nonstop therapy and sparing them the destabilizing hemodynamic and electrolytic changes characteristic of IHD. Many clinicians have reported that CRRT's steady, milder treatment is less traumatic for some of their patients than IHD. For acute renal failure patients who can't tolerate IHD--usually those with very low blood pressure--CRRT is often the only choice of treatment. CRRT can also be used on many patients who can tolerate IHD. But because there is little useful survival data concerning CRRT, and because CRRT is sometimes perceived as significantly more expensive than IHD, some hospital administrators have--groundlessly, we believe--questioned the wisdom of investing in this technology. In this article, we examine CRRT's benefits and take a close look at some of the myths that have impeded its adoption.