Renal Replacement Therapy in the Critical Care Setting

Table 4

Comparison of various RRT modalities.

	IHD	SLED	CRRT
Cost	+	++	++++
Duration	4 hrs daily; /alternate days	6–12 hrs daily; /alternate days	24 hrs (though achieves 16 hrs on avg.); Continuous
Haemodynamic instability	Least suitable	Good	Most compatible
Compatible with extracorporeal life support	No	No	Yes
In raised intracranial pressure	Increases	Can increase	Usually no change
Anti-coagulation	Can be omitted	Can be omitted	Predilution can be utilised to maintain circuit
Serum concentration of renally cleared drugs	Major fluctuations	Some fluctuation	Least fluctuation
Vascular access	AV fistula or nontunnelled or tunnelled catheter	AV fistula or nontunnelled or tunnelled catheter	Nontunnelled or tunnelled catheter
Compatible with supporting large volume infusions (antibiotics, nutrition, etc.)	No	Would need to be daily and longer sessions	Most compatible
Mobilisation	Most compatible	Could be compatible if done at night/rest time	Not compatible—would need to be discontinued.

IHD : intermittent haemodialysis; SLED : sustained low-efficiency dialysis; CRRT : continuous renal replacement therapy.