Intermittent versus continuous renal replacement therapy: a matter of controversy.
BACKGROUND
Acute Renal Failure (ARF) requiring some form of replacement therapy is a frequent complication in the critically ill patient. Despite potential therapeutic advantages the expectation of an improvement in patient outcomes using Continuous Renal Replacement Therapy (CRRT) compared to conventional Intermittent Haemodialysis (IHD) remains controversial.


OBJECTIVE
This article will review the literature on the issues surrounding the use of IHD versus CRRT in the management of the critically ill patient. Articles were selected according to level of evidence with priority given to meta-analyses and randomised controlled trials.


CONCLUSIONS
Several operational features of CRRT allow this technique to be tolerated more easily in critical illness than IHD. The gradual removal of fluid reduces the incidence of hypotension and the risk of volume overload. Decreased variability in the concentration of solutes enables greater azotemia control. However, CRRT is required to operate uninterrupted to achieve a treatment dose that is equivalent to a conventional IHD treatment schedule. In the absence of definitive evidence to validate superior patient survival and return of renal function there is disagreement as to the most appropriate form of Renal Replacement Therapy (RRT) for the critically ill patient. The introduction of 'hybrid' therapies offers a further alternative treatment strategy, which combine favourable aspects of IHD and CRRT.


CONCLUSIONS
The decision to use IHD or CRRT should be guided by the therapeutic needs of the patient rather than the operational differences between the two techniques. The resources and expertise available at the organisation are also important in determining the mode best able to manage the critically ill patient at any stage and may change according to the severity of illness. The emergence of hybrid therapies provides a compromise option which encompasses many of the features of both systems, but does not embrace all options of either approach.
Davies
Hugh T
HT
Intensive Care Unit, Royal Perth Hospital, Curtin University of Technology, Western Australia, Australia. hugh.davies@health.wa.gov.au
Leslie
Gavin D
GD
D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D001672:Biocompatible Materials; D003422:Critical Care; D034462:Dissent and Disputes; D019317:Evidence-Based Medicine; D006301:Health Services Needs and Demand; D006440:Hemofiltration / Q000009:adverse effects / Q000145:classification / Q000191:economics / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007688:Kidneys, Artificial; D015201:Meta-Analysis as Topic; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects / Q000145:classification / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology / Q000209:etiology
D000925:Anticoagulants; D001672:Biocompatible Materials