What is the effect of renal replacement therapy (RRT) modality on renal recovery in critically ill patients?
I am Hilde De Geus from The Netherlands and that was the focus of my lecture—looking specifically at whether the choice between hemofiltration and dialysis impacts renal outcomes.
There's a common myth in intensive care that hemofiltration is somehow superior for renal recovery. However, the literature I presented clearly shows that there is no significant difference between hemofiltration and hemodialysis in terms of their impact on renal recovery.
While convective therapies like hemofiltration may provide more efficient clearance of large molecules, this does not translate into improved renal outcomes. On the other hand, dialysis offers more favorable technical characteristics:
Lower blood flow requirements
Lower filtration fraction
These make it more practical and sustainable in critically ill patients.
So, the main takeaway is this:
There is no clear advantage of hemofiltration over dialysis in terms of renal recovery, and based on technical simplicity and physiological tolerance, continuous hemodialysis may be the more logical choice in many ICU settings.
As for the broader question—does RRT influence renal recovery at all?—the evidence suggests that the modality itself is not the determining factor. This is an area where more nuanced understanding is needed, but we should be cautious about assigning undue benefit to one approach over another without clear evidence.
This congress is truly well-educated and evidence-based. The level of discussion is state-of-the-art, and it's an honor for me to be here as a speaker. I would strongly encourage others to attend—because if you want to stay up to date with the latest, most reliable evidence in fluid and renal care, this is the place to be.
