CONTINUOUS AND INTERMITTENT RENAL REPLACEMENT THERAPY FOR ACUTE KIDNEY INJURY IN INTENSIVE CARE UNITS

Abstract

Acute kidney injury is common in critically ill patients and is associated with high mortality and morbidity. In patients with severe acute kidney injury, renal replacement therapy represents a cornerstone of treatment.

Continuous and intermittent renal replacement therapies are equivalent dialysis strategies regarding outcome for the intensive care unit patient with acute kidney injury, with a few exceptions for specific problems that are a direct indication for either one or the other strategy.

Advantages of continuous renal replacement therapy are its potential for more fluid removal in severely overloaded patients, its potential – however hardly proven – for better hemodynamic stability in severely unstable patients, and its better tolerability in combined acute liver and kidney failure and in acute brain injury.

Intermittent renal replacement therapies is more practical, flexible and cost-effective, allows the clinician to discontinue or to minimize anticoagulation with bleeding risks, and removes small solutes such as potassium more efficiently in acute life-threatening conditions.

Sustained low efficiency dialysis is a hybrid therapy combining most of the advantages of both options. All these options should not be considered as competitors, but rather as alternatives that may be switched in the same patient depending on the condition and the possibilities at a given moment in a given unit. From the practical point of view, among these modalities, sustained low efficiency dialysis seems to offer the highest flexibility to tailor treatment according to the individual needs of the patient.