Table 3: Theoretical advantages and disadvantages of different renal replacement modalities.
Techniques | Solute transport | Duration of therapy/session (hr.) | Advantages | Disadvantages |
---|---|---|---|---|
IHD | Diffusion | 4 | - Rapid removal of uremic toxins and small molecule clearance - Technically simple - Relatively low cost - Patients mobility |
- Increased risk of hypotension and disequilibrium - Require vascular access and anticoagulant |
PD | Diffusion | 24 | - Technically simple - Require less infrastructure - No anticoagulation required - Less hemodynamic instability - Relatively low cost |
- Slow small molecule and uremic toxin clearance - Unpredictable fluid removal - Risk of peritonitis - May compromise respiratory function |
PIRRT | Diffusion | 6-12 | - More rapid solutes and uremic toxin removal than CRRT, but slower than IHD - More hemodynamically stable than IHD - Technically simple - Relatively low cost - Patients mobility |
- Require vascular access and anticoagulant - Risks of hypotension and disequilibrium |
CVVHF | Convection | 24 | - Increased middle molecule and cytokines removal from convective technique - Continuous removal of uremic toxins and fluid - More hemodynamically stable than IHD |
- Complex circuit - High cost - Require vascular access and anticoagulant and prolonged use of anticoagulant - Patient immobility |
CVVHD | Diffusion | 24 | - Continuous removal of uremic toxins and fluid - More hemodynamically stable than IHD |
- Complex circuit - High cost - Require vascular access and anticoagulant and prolonged use of anticoagulant - Patient immobility |
CVVHDF | Diffusion and convection | 24 | - Increased middle molecule and cytokines removal from convective technique - Continuous removal of uremic toxins and fluid - More hemodynamically stable than IHD |
- Complex circuit - High cost - Require vascular access and anticoagulant and prolonged use of anticoagulant - Patient immobility |
IHD: Intermittent Hemodialysis; PD: Peritoneal Dialysis; PIRRT: Prolonged Intermittent Renal Replacement Therapy; CVVHF: Continuous Venovenous Hemofiltration; CVVHD: Continuous Venovenous Hemodialysis; CVVHDF: Continuous Venovenous Hemodiafiltration.