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Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient:

Paul M Palevsky1

  • 1Kidney Medicine Section, Medical Service, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Clinical Journal of the American Society of Nephrology : CJASN
|February 9, 2023
PubMed

Insights

The best kidney replacement therapy (KRT) for acute kidney injury (AKI) remains debated. More data is needed to guide a patient-focused approach for critically ill patients requiring KRT.

Area of Science:

  • Nephrology
  • Critical Care Medicine

Background:

  • The optimal modality for kidney replacement therapy (KRT) in acute kidney injury (AKI) is a long-standing debate.
  • Current guidelines suggest intermittent hemodialysis and continuous KRT (CKRT) are complementary, favoring CKRT for unstable patients.

Purpose of the Study:

  • To present a virtual debate on the use of intermittent hemodialysis versus continuous KRT (CKRT) for critically ill patients with AKI.
  • To explore arguments for and against intermittent hemodialysis in AKI management.

Main Methods:

  • Virtual debate format featuring advocates for and against intermittent hemodialysis.
  • Review of observational data and clinical practice guidelines regarding KRT modalities in AKI.

Main Results:

  • Arguments for and against intermittent hemodialysis in AKI were presented.
  • Observational data suggesting impaired kidney function recovery with intermittent hemodialysis was discussed.

Conclusions:

  • The debate highlights the need for more data to inform KRT selection in AKI.
  • A pragmatic, patient-focused approach to KRT delivery for critically ill AKI patients is advocated.

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