Table 1. Intermittent vs Continuous vs Extended Dialysis.
Advantages | Disadvantages | Contraindications | |
---|---|---|---|
Intermittent
Hemodialysis (IHD) |
• Short duration
• No/short/less anticoagulation (reduced risk of bleeding). • Higher efficiency for immediate small water-soluble removal (life-threatening hyperkalemia) • Less bed rest • Flexibility of use: machines can be used in an extended protracted mode (increase in efficacy) • Bags cost saving |
• Technical skills (trained
personnel) and technical infrastructure (dedicated areas with water connection) • Clearance rebound • Hemodynamic impact/instability • Potential higher risk of dialysis dependence |
• Traumatic brain
injury |
Continuous Renal
Replacement Therapy (CRRT) |
• Hemodynamic stability (less
cardiovascular impact) → higher potential recovery of kidney function • ICU staff may handle these treatments autonomously • Superior solute removal and volume control (in a 24 hours lasting session) • Administration of parenteral nutrition fluids |
• Downtime may impair efficiency
• Continuous systemic (heparin) or regional (citrate) anticoagulation (higher risk of patient’s bleeding or filter clotting) • Bed rest is necessary • Higher cost • Lower efficiency than IHD (hyperkalemia) • Risk of hypothermia |
• Patients needing
mobilization |
Sustained Low-Efficiency
Daily Dialysis (SLEDD) or Prolonged intermittent RRT (PIRRT) |
• Easy
• Good flexibility of sessions administration (6–12 hours or overnight treatment) • Higher possibility for patient mobility • Hemodynamic stability • Relatively low anticoagulation requirement • Bags cost saving |
• Technical skills (trained
personnel) and technical infrastructure (dedicated areas with water connection) • Hypophosphatemia • Hypothermia • Low efficiency |
• None |