Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders>>>>>Renal Replacement Therapy
Question 1#

Which of the following statements is MOST likely to be true of continuous renal replacement therapy (CRRT) in comparison to intermittent hemodialysis (IHD):

A. CRRT is more likely to induce dialysis-associated increase in intracranial pressure
B. CRRT is associated with less hemodynamic changes during treatment
C. CRRT allows for earlier mobilization of patients
D. CRRT is less efficient in removing solutes and fluid

Correct Answer is B

Comment:

Correct Answer: B

IHD is an efficient dialysis technique, which is performed over 3 to 4 hours. CRRT is less efficient, as it is continuous over an entire 24-hour period. IHD allows for early mobilization of patients compared to CRRT but is not tolerated well in hemodynamically unstable patients. Hence the most recent KDIGO guidelines recommend CRRT in hemodynamically unstable patients. Dialysis-induced increase in intracranial pressure is more likely to occur in patients undergoing IHD. This is postulated to occur due to the rapid removal of solutes and consequent fluid shifts. The slower fluid and solute removal with CRRT minimizes its occurrence.

References:

  1. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl. 2012;2(1). Section 5, Chapter 5.6.
  2. Gemmell L, Docking R, Black E. Renal replacement therapy in critical care. BJA Educ. 2017;17(3):88-93.