Multiple large studies from different continents have demonstrated better renal recovery when CRRT was used.1,2,3 Summarizing the results of these and many further studies, Schneider et al. concluded in a meta-analysis, that patients starting treatment of AKI with an intermittent RRT modality “had a 1.7 times increased risk of remaining dialysis dependent as compared with those who initially received CRRT”.4
More recently, Wald et al. published the results of the so far largest study comparing outcome after use of CRRT and iHD.5 This study clearly shows that starting the treatment of AKI with CRRT is associated with significantly better recovery of renal function and a lower incidence of chronic dialysis dependence.
As costs of subsequently needed chronic dialysis have a huge economic impact, Bellomo and Schneider conclude in an accompanying editorial: “The economic case for using conventional IHD [iHD instead of CRRT] collapses as the real cost of IHD is revealed by the study by Wald et al”.6
In addition to pure economic evaluations, avoiding chronic dialysis after an AKI episode is an important medical and ethical goal given the high burden for the patient associated with chronic dialysis, further supporting the choice of CRRT as initial treatment modality in AKI.