CRRT better treatment option for patients with acute renal failure
As technology advances, medical facilities too are progressing. Instead of waiting for their death due to unavailability of kidney donor, those ailing with renal failure now have multiple treatment options. Of the many methods available, Continuous Renal Replacement Therapy (CRRT) is one of the treatment options for patients with renal failure.
Continuous Renal Replacement Therapy (CRRT) is a slow and continuous blood purification therapy. In addition to the cleansing of the blood in the dialyzer, in this CRRT procedure the ultrafiltrate or extract of the blood containing wastes is removed and is replaced by a clean IV solution. CRRT is best suited option for patients with acute renal failure (ARF) who also suffer from severe complications, such as multiple organ failure and who cannot tolerate conventional intermittent hemodialysis (IHD) due to hemodynamic instability. This CRRT can only be performed in the ICU setting as it requires very close monitoring.
Since this CRRT procedure entails slow and continuous removal of solutes, this facilitates the transfer of solutes from the tissue to the blood and enables to remove the uremic toxins in the tissue along with the uremic toxins in the blood. CRRT using a high permeable hemofilter can remove high molecular weight solutes as well. The solute removal with CRRT is achieved either by convection (hemofiltration), diffusion (hemodialysis), or a combination of both these methods (hemodiafiltration). The hemodialysis process most efficiently removes small molecular weight substances such as urea, creatinine, and potassium. Middle and larger molecular weight substances are more efficiently removed using hemofiltration. However, the choice of modality is dependent on several factors including availability, cost, physician expertise, hemo-dynamic stability, and the primary purpose of the procedure.
Meanwhile, compared to the conventional therapy, CRRT is significantly more expensive. However, CRRT has several theoretical advantages over intermittent blood purification techniques, including better hemodynamic tolerability, more efficient solute clearance, better control of intravascular volume, and better clearance of middle and large molecular weight substances. Above all, one of the major advantages of CRRT is the slower rate of solute or fluid removal per unit of time. Although the clearance rate of small solutes is slower per unit time with CRRT but it is continuously administered, hence the urea clearance is more efficient compared to the alternate day intermittent hemodialysis. Thus CRRT is generally better tolerated than conventional therapy since many of the complications of intermittent hemodialysis (HD) are related to the rapid rate of solute and fluid loss.