We Restrict CRRT to Only the Most Hemodynamically Unstable Patients

From the initial version of an extended renal replacement therapy, the initiative to provide safer, more efficient means for detoxification and volume removal in comparison with intermittent renal replacement therapies (IRRT) has been evaluated. As a result, the Kidney Disease Improving Global Outcomes guidelines for acute kidney injury recommend the preferential use of continuous renal replacement therapy (CRRT) in patients who are hemodynamically unstable or who suffer from intracranial hypertension. The choice of dialysis modality is also influenced by other factors including clinical expertise, and the availability of each treatment option in individual medical centers. In the scientific community, there is an ongoing debate regarding the choice of dialysis modality. On one side, the inability of recent studies to demonstrate any mortality or renal recovery benefit for CRRT, the need for patient immobilization, and prohibitive additional costs impede widespread adoption of the method.On the other side, the physiological advantages of CRRT in detoxification and volume removal and the identified flaws related to the comparative literature regarding CRRT and IRRT fuel this debate. Fluid overload is a recognized and yet clinically underappreciated factor that increases morbidity and mortality in the intensive care unit (ICU). Continuous renal replacement therapy has a distinct advantage over IRRT in achieving euvolemia and thus the potential for improving outcomes in all patients in the ICU setting in which extensive fluid administration is often obligatory. With this in mind, perhaps CRRT should not be restricted to only those patients in whom their hemodynamic status requires it. This article reviews the current literature and the myths that may influence the selection of one mode of therapy over the other among patients requiring renal replacement therapy in the ICU.