In AKI due to sepsis, which renal replacement therapy is commonly initiated when indicated?

• A. Hemodialysis or CRRT depending on hemodynamic stability
• B. Peritoneal dialysis
• C. Continuous venovenous hemofiltration
• D. No renal replacement therapy

Answer: (A)

When AKI from sepsis reaches a point where renal replacement therapy is needed, the chosen modality is guided by how stable the patient is hemodynamically. Sepsis often causes low blood pressure and reliance on vasopressors, so a gentler, continuous approach is preferred. Continuous renal replacement therapy (CRRT) provides slow, continuous solute and fluid removal, which helps avoid abrupt shifts in blood pressure and improves tolerance in unstable patients. If the patient is hemodynamically stable, intermittent hemodialysis can be used to correct electrolyte and fluid issues more quickly in shorter sessions. Thus, initiating renal replacement therapy with either hemodialysis or CRRT depending on stability is the commonly used strategy. Peritoneal dialysis is less commonly started in this acute, septic ICU setting due to practical limitations and slower clearance, making it a less typical first choice in this scenario.