Which renal replacement therapy modality provides continuous solute clearance with minimal hemodynamic impact?

• A. CRRT (CVVH/CVVHD/CVVHD)
• B. Intermittent hemodialysis
• C. Peritoneal dialysis
• D. Hemofiltration

Answer: (A)

Continuous renal replacement therapy provides gentle, ongoing clearance of solutes and fluids, run continuously over 24 hours. This slow, steady approach allows precise control of the rate of solute removal and fluid balance, which helps keep blood pressure and perfusion stable in patients who are hemodynamically unstable. The therapy can use convection (CVVH), diffusion (CVVHD), or a combination (CVVHDF), all aiming to remove waste products like urea and manage volume without causing large shifts that could compromise hemodynamics. Intermittent dialysis delivers rapid clearance in shorter sessions, often leading to abrupt fluid and electrolyte shifts and potential hypotension—hence less suitable for unstable patients. Peritoneal dialysis is continuous as well but may be slower and subject to other limitations in the ICU setting. Therefore, for continuous solute clearance with minimal hemodynamic impact, CRRT is the best choice.