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

• Published in: Clinical journal of the American Society of Nephrology Vol. 18; no. 5; pp. 644 - 646
• Main Author: Palevsky, Paul M
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.05.2023
• Subjects: Critical Care Nephrology and Acute Kidney Injury
• ISSN: 1555-9041; 1555-905X; 1555-905X
• DOI: 10.2215/CJN.0000000000000116

The selection of modality of kidney replacement therapy has been debated for decades. Although the KDIGO Clinical Practice Guidelines for Acute Kidney Injury consider intermittent hemodialysis and continuous kidney replacement therapy (CKRT) to be complementary therapies, with a recommendation to preferably use CKRT in hemodynamically unstable patients, there is a vocal cadre of practitioners and investigators who argue that CKRT is the only modality that should be used to support critically ill patients with acute kidney injury, relying on observational data to argue that intermittent hemodialysis is associated with impaired recovery of kidney function. In this issue of CJASN we have provided a virtual debate allowing advocates for and against the use of intermittent hemodialysis to make their best cases. In the end, their arguments converge, with a call for more data and a pragmatic, patient-focused approach to the delivery of KRT to critically ill patients with acute kidney injury.