Renal replacement therapy in acute kidney injury: which method to use in the intensive care unit?

Over the last three decades the treatment options for patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have expanded from basic acute peritoneal dialysis and intermittent hemodialysis (IHD), to now include a variety of continuous modalities (CRRT), ranging from hemofiltration, dialysis and/or hemodiafiltration, and a variety of hybrid therapies, variously described as extended daily dialysis and/or hemodiafiltration, with the possibility of additional adjunct therapies encompassing plasma separation and adsorption techniques. Current evidence does not support that one modality is superior to any other in terms of patients' survival in the intensive care unit, or at discharge. There have been two prospective audits, which have reported improved renal recovery in the survivors who were treated by CRRT rather than IHD, but this has not been confirmed in randomized controlled trials. Thus the choice of RRT modality should be guided by the individual patients' clinical status, the medical and nursing expertise in the local intensive care unit, and the availability of RRT modality.