Continuous vs. Intermittent Renal Replacement Therapy for Acute Renal Failure

Acute renal failure (ARF) requiring dialysis is a common and frequently lethal problem encountered in the intensive care unit (ICU). Despite two multicenter trials and a meta-analysis, a survival benefit for continuous venovenous hemofiltration (CVVH) versus intermittent hemodialysis (IHD) renal replacement therapy has not been convincingly demonstrated. Schefold and colleagues conducted the CONVINT trial (continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure) to study the impact of the initial choice of renal replacement therapy on patient outcomes in a medical ICU.

The authors concluded that IHD and CVVH might be considered equivalent approaches for a population of critically ill patients with dialysis-dependent ARF treated in a medical ICU. The study has several major limitations. For example, CVVH dosing practices used may differ from those employed at other institutions, potentially limiting the external generalizability. Nevertheless, data from this trial add to the accumulating evidence that CVVH may be equivalent to IHD in selected ICU populations.

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