[Continuous vs intermittent renal replacement therapies in acute renal failure: toward an agreement?]

Many studies have addressed the question of renal replacement therapy (RRT) modalities in patients with acute kidney injury (AKI) in the intensive care setting. There is no definite evidence of the superiority of one RRT modality over another. Despite major advances in both intermittent and continuous RRT delivery, no real mortality benefit, nor better renal function recovery, have been demonstrated so far with any of the RRT modalities. However, nephrologists and intensivists are periodically faced with the debate on the superiority - or lack thereof - of RRT techniques. The ideal RRT modality for patients with AKI in the ICU probably does not exist, and a more rational approach should be based on the judicious utilization of all the modalities currently available in the ICU, tailoring RRT on the basis of the changing needs of the patients along their clinical course. An important improvement in the approach to RRT in the critical care setting could be the so-called hybrid or prolonged intermittent RRT techniques (e.g., sustained low-efficiency dialysis or SLED), that seem to share most of the advantages of both classical (i.e., short-duration) intermittent and continuous modalities, without their shortcomings.