Single-best Choice Between Intermittent Versus Continuous Renal Replacement Therapy: A Review

Area of Science:

• Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Critically ill patients frequently develop multiorgan dysfunction syndrome, with acute kidney injury (AKI) being a common component.
• Renal replacement therapy (RRT) is the primary treatment for AKI in severe cases, with increasing utilization.
• The selection of an appropriate RRT modality significantly impacts renal recovery in AKI patients.

Purpose of the Study:

• To summarize the advantages and disadvantages of various RRT techniques.
• To assess the potential for routine implementation of sustained low-efficiency daily dialysis (SLEDD) as a preferred RRT method.

Main Methods:

• Comparative review of intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and sustained low-efficiency daily dialysis (SLEDD).
• Analysis of RRT modalities based on fluid removal, solute control, acid-base balance, hemodynamic stability, practicality, cost-effectiveness, and bleeding risk.

Main Results:

• CRRT offers gradual fluid removal and better hemodynamic stability but is complex.
• IHD provides efficient solute removal and is cost-effective but carries bleeding risks.
• SLEDD and prolonged intermittent renal replacement therapy (PIRRT) aim to combine the benefits of CRRT and IHD.

Conclusions:

• SLEDD is gaining popularity as an alternative RRT, though evidence supporting its routine use is limited.
• Further research is needed to establish SLEDD as the single-best choice for RRT in AKI patients.
• The optimal RRT modality choice depends on individual patient factors and clinical context.