Continuous renal replacement therapy: opinions and evidence

Area of Science:

• Nephrology
• Intensive Care Medicine
• Critical Care

Background:

• Continuous arteriovenous haemofiltration (CAVH) pioneered continuous renal replacement therapy (CRRT).
• CRRT has evolved with pump technology (CVVH) and central venous catheters, becoming standard in many intensive care units (ICUs), particularly in Australia and Europe.
• Initial use for diuretic-unresponsive fluid overload has expanded significantly.

Purpose of the Study:

• To provide a dispassionate distillation of the literature on CRRT.
• To differentiate established evidence from opinions regarding CRRT's current applications and controversies.
• To define the current state of CRRT based on scientific evidence.

Main Methods:

• Literature review and synthesis of existing studies on CRRT.
• Analysis of the evolution and expanded indications of CRRT.
• Identification and evaluation of controversies surrounding CRRT.

Main Results:

• CRRT, including CAVH and CVVH, is a dominant form of renal support in ICUs.
• Indications for CRRT have broadened to include drug intoxications, cardiac failure, cardiopulmonary bypass management, chemotherapy toxicity, and potential sepsis adjuvant therapy.
• Despite widespread use, controversies persist regarding CRRT's efficacy and optimal application.

Conclusions:

• CRRT has evolved from its initial application for fluid overload to a versatile therapy with numerous indications.
• Further research and evidence-based evaluation are needed to resolve current controversies surrounding CRRT.
• A clear definition distinguishing evidence-based applications from opinions is necessary for the optimal use of CRRT.