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Author Topic: CRRT and the risk of chronic dialysis
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Post CRRT and the risk of chronic dialysis
on: March 16, 2012, 19:45
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does doing CRRT on a patient pose an additional risk in itself for needing dialysis in the future? Thanks...

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Post Re: CRRT and the risk of chronic dialysis
on: March 16, 2012, 19:58
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This is a great question. Before I give my 2 cents, allow me to provide a bit more background to your question.

We know that acute renal failure (ARF) patients who require renal replacement therapy (RRT) can have a higher risk of developing chronic kidney disease. This is, in part, because of 1) the severity of their underlying disease(s) (which led to the need for RRT in the first place) and 2) the hemodynamic changes (especially renal perfusion) that occurs while on a hemodialysis machine.

CRRT (continuous renal replacement therapy) is considered a more gentler form of hemodialysis than an intermittent hemodialysis (IHD) session. Should a gentler form of hemodialysis (CRRT) pose the same risk of developing CKD as the harsher, more aggressive IHD?

On the surface, the answer appears to be in favor of CRRT. That is, that administering CRRT to a patient would lead to a less risk of developing CKD as a result of the dialysis process itself than if you administered IHD. However, dig deeper and you will realize that patients who are placed on CRRT are usually much sicker than those receiving IHD. So, perhaps their underlying medical conditions, and not the CRRT process itself, will increase their risk of developing CKD. In other words, whatever benefit you get by placing someone on CRRT (benefit = the lower risk of developing CKD from the dialysis process itself), is offset by the fact that the patient is sicker at baseline.

Given this conundrum, we need the evidence to be the arbiter. A number of studies suggest that the risk of developing CKD is no different in ARF patients who receive CRRT than ARF patients who receive IHD:
1)http://www.ncbi.nlm.nih.gov/pubmed/17636735
2) http://www.ncbi.nlm.nih.gov/pubmed/18474503

Some of the more recent retrospective analyses suggest that mortality is improved in ARF patients who receive CRRT than IHD, but they don't seem to comment on the risk of developing CKD (perhaps because CKD is not considered a terrible outcome compared to other outcomes).

All-in-all, I would say the risk of developing CKD is great in any ARF patient that requires RRT, and that the choice of CRRT versus IHD should be guided more on other factors (like mortality, or ability to tolerate hemodynamic shifts) more than the risk of developing CKD.

Hope this helps.

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