June 1, 2007

Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure.

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Critical Care
  • Ron Wald

    While 4 RCTs have shown no advantage of CRRT over IHD in terms of short-term survival, the study by Bell et. al. suggests that the benefit of CRRT lies in the higher likelihood of renal recovery seen with this modality. This is an important finding that counters the disappointing results seen with CRRT, an intervention that is also saddled by higher costs and labour intensiveness as compared to intermittent dialysis.

    The study results are hampered by the potential for residual confounding, as severity of illness and baseline kidney function were not included as covariates in the regression analysis that demonstrated superior renal survival with CRRT. Moreover, nearly 90% of patients received CRRT, which appears to have been the standard of care in Sweden. This raises questions about the type of patients who were selected for the clearly less-popular IHD modality as well as the experience and skill of the medical and nursing teams in administering IHD.