Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: Moderator Commentary

The selection of modality of kidney replacement therapy (KRT) has been debated for decades. Although the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury considers intermittent hemodialysis and continuous KRT (CKRT) to be complementary therapies, with a recommendation to preferably use CKRT in hemodynamically unstable patients, there is a vocal cadre of practitioners and investigators who argue that CKRT is the only modality that should be used to support critically ill patients with AKI, relying on observational data to argue that intermittent hemodialysis is associated with impaired recovery of kidney function. In this issue of CJASN, we have provided a virtual debate allowing advocates for and against the use of intermittent hemodialysis to make their best cases. In the end, their arguments converge, with a call for more data and a pragmatic, patient-focused approach to the delivery of KRT to critically ill patients with AKI.