Intermittent versus continuous renal replacement therapy: a matter of controversy
Hugh T Davies1, Gavin D Leslie
1Intensive Care Unit, Royal Perth Hospital, Curtin University of Technology, Western Australia, Australia. hugh.davies@health.wa.gov.au
Intensive & Critical Care Nursing
|April 9, 2008
Summary
Continuous Renal Replacement Therapy (CRRT) offers benefits for critically ill patients with acute renal failure, but its superiority over Intermittent Haemodialysis (IHD) is debated. Hybrid therapies present a new alternative.
Area of Science:
- Nephrology
- Critical Care Medicine
- Intensive Care Unit Management
Background:
- Acute Renal Failure (ARF) is common in critically ill patients.
- The use of Continuous Renal Replacement Therapy (CRRT) versus Intermittent Haemodialysis (IHD) for ARF in critical illness is controversial.
- Evidence for improved patient outcomes with CRRT over IHD remains inconclusive.
Purpose of the Study:
- To review the literature comparing IHD and CRRT in critically ill patients.
- To analyze the operational differences and clinical implications of IHD and CRRT.
- To discuss the role of hybrid therapies as an alternative treatment strategy.
Main Methods:
- Literature review prioritizing meta-analyses and randomized controlled trials.
- Comparative analysis of IHD and CRRT based on available evidence.
- Evaluation of operational features and patient outcomes.
Main Results:
- CRRT offers easier tolerance in critical illness due to gradual fluid removal, reducing hypotension and volume overload.
- CRRT provides better azotemia control through decreased solute concentration variability.
- Uninterrupted operation of CRRT is necessary for treatment dose equivalence to IHD.
Conclusions:
- Disagreement exists on the optimal Renal Replacement Therapy (RRT) for critically ill patients due to lack of definitive evidence on survival and renal function recovery.
- Patient's therapeutic needs, rather than operational differences, should guide RRT decisions.
- Organizational resources and expertise are crucial in selecting the appropriate RRT modality, with hybrid therapies offering a compromise.
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