Choice of therapy and renal recovery

Abstract

To describe the impact of choice of therapy on renal recovery. Literature review. Randomized controlled trials conducted have not shown a benefit of continuous renal replacement therapy in mortality over intermittent renal replacement therapy. However, renal recovery is another important outcome for patients with acute kidney injury and may be affected differently by intermittent renal replacement therapy and continuous renal replacement therapy. Because of its rapid changes in fluid status and plasma osmolality, intermittent renal replacement therapy induces a decrease in venous return and can induce intradialytic hypotension. Because of this effect, intermittent renal replacement therapy may cause renal ischemia and delay renal recovery. Observational studies, including two large epidemiologic studies, suggest that continuous renal replacement therapy may be able to reduce chronic dialysis dependence. On the other hand, randomized controlled trials conducted so far do not support an effect of continuous renal replacement therapy over intermittent renal replacement therapy in relation to renal recovery. However, all of these randomized studies have significant limitations including sample size, study design, and randomization. Although there is much suggestive evidence that continuous renal replacement therapy may increase the rate of renal recovery, such evidence is insufficient to fully elucidate the impact of choice of therapy on this outcome. Appropriately planned trials will be required to address this issue.