Table 1.

Advantages and disadvantages of various renal replacement therapy modalities

Modality	Advantages	Disadvantages	Appropriate setting
IHD	Rapid removal of toxins and low molecular weight substances	Rapid fluid removal leading to hypotension	Hemodynamically stable patients with hyperkalemia, metabolic acidosis, or poisoning with a dialyzable toxin
		Dialysis disequilibrium and cerebral edema
	Allows “down time” for diagnostic and therapeutic procedures	Requires treated water and concentrates
	Reduced exposure to anticoagulation; hence, lower bleeding risk	Not possible to combine with other organ support systems
	Lower costs than CRRT (around INR 2,000 daily in India)
CRRT	Continuous removal of toxins	Slower clearance of toxins	Hemodynamically unstable patients with pulmonary edema, liver disease, or increased intracranial pressure
	Less hypotension and need for escalation of vasopressors	Need for prolonged anticoagulation	Can be easily and appropriately coupled with other extracorporeal organ support systems
	Easy control of fluid balance because of unlimited fluid removal	Dedicated filter sets and sterile fluid bags required
	Allows adequate nutrition even in anuric patients	Patient immobilization or frequent interruptions compromising adequate solute and fluid removal
	User-friendly interactive machines	Increased infection risks
	Some middle-molecular-weight solute possible	High costs (around INR 25,000 to 30,000 daily for average adult)
SLED	Slower volume and solute removal	Slower clearance of toxins	Hemodynamically unstable
	Hemodynamic stability		Can be coupled with other extracorporeal organ support systems
	Successfully performed without anticoagulation
	Allows “down time” for diagnostic and therapeutic procedures
	Same machines may be used for more than one treatment per day, or for acute HD, SLED, or even maintenance HD
	Lower cost (around INR 2,500–3,000 daily, upto 7,000 if SLEDD-f)
PD	Hemodynamic stability	Inadequate clearance in hypercatabolic patients	Hemodynamically unstable with coagulopathy, difficult access, increased risk of cerebral edema in underresourced regions
	Technically simple	Protein loss	Stand-alone therapy not possible to combine with any other support system
	No anticoagulation	No control of rate of fluid removal
	No need for vascular access	Risk of peritonitis
	Lower cost (around INR 1,000–2,000 daily)	Hyperglycemia
	Gradual removal of toxins	Requires intact peritoneal cavity
		Impairs diaphragmatic movement, potential for respiratory problems