Related Experiment Video
Updated: Aug 12, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: The
Khalil Chaïbi1,2, Didier Dreyfuss2,3,4, Stéphane Gaudry1,2,5
1AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, Bobigny, France.
Insights
The choice between intermittent hemodialysis (HD) and continuous KRT (CKRT) for acute kidney injury (AKI) lacks clear evidence of superiority. Current guidelines suggest focusing on organizational factors rather than assuming one therapy is better.
Area of Science:
- Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Kidney replacement therapy (KRT) is crucial for severe acute kidney injury (AKI).
- Intermittent hemodialysis (HD) and continuous KRT (CKRT) are primary treatment modalities for critically ill AKI patients.
- CKRT is often preferred due to perceived benefits in hemodynamic tolerance and kidney function recovery.
Purpose of the Study:
- To reevaluate the choice between intermittent HD and CKRT for AKI.
- To assess the current evidence comparing HD and CKRT, considering recent advancements and patient populations.
- To provide guidance on KRT modality selection based on clinical outcomes, resources, and logistics.
Main Methods:
- Review of existing randomized controlled trials (RCTs) comparing HD and CKRT.
- Analysis of recent studies on KRT initiation and patient recovery without therapy.
- Consideration of health technology assessments on cost-effectiveness.
Main Results:
- Past RCTs (over 15 years old) showed no significant benefit of CKRT over HD in mortality, hemodynamics, or kidney function recovery.
- Recent studies indicate lower mortality rates and a notable proportion of AKI patients who may recover without KRT.
- Evidence on the cost-effectiveness of HD versus CKRT is conflicting.
Conclusions:
- There is insufficient evidence to support the superiority of one KRT modality (HD or CKRT) over the other.
- The selection of KRT should consider organizational factors and resource availability in the absence of proven clinical benefits.
- Further RCTs are needed to reevaluate KRT initiation and management strategies in AKI.
Abstract:
Kidney replacement therapy (KRT) plays a major role in the treatment of severe AKI. Intermittent hemodialysis (HD) and continuous KRT (CKRT) are the main modalities in critically ill patients with AKI. CKRT is the preferred modality in many countries because of its alleged superiority on both hemodynamic tolerance and on kidney function recovery. In fact, randomized controlled trials (RCTs) comparing the two modalities have not shown any actual benefit of one technique over the other on mortality, hemodynamics, or kidney function recovery. Those RCTs were conducted more than 15 years ago. Major progress was eventually made leading to much lower mortality rates in recent studies than in previous studies. In addition, those RCTs included a noticeable proportion of patients who could have recovered without ever receiving KRT, as demonstrated by several recent studies. In the absence of evidence of clinical superiority of one KRT modality, the choice must be addressed not only regarding clinical outcome but also resources and logistics. Conclusions of health technology assessments and study reports were heterogeneous and conflicting concerning cost-effectiveness of intermittent HD versus CKRT. All these considerations justify a reevaluation of the issue in new RCTs that take into account recent knowledge on KRT initiation and management. Pending results of such study, the choice should be guided mainly by organizational considerations in each unit and without condemning any modality in the absence of proof.
Related Concept Videos
01:30Continuous Renal Replacement Therapy
01:20Acute Kidney Injury V: Interprofessional Care
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:28Chronic Kidney Disease III: Interprofessional Care
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:25Hemodialysis III: Nursing Management