In septic patients with AKI who are hemodynamically unstable, which renal replacement therapy is preferred?

• A. Continuous renal replacement therapy (CRRT) or hemodialysis, depending on stability
• B. Peritoneal dialysis
• C. Intermittent hemodialysis only
• D. No renal replacement therapy

Answer: (A)

In septic AKI with hemodynamic instability, the priority is to support perfusion while correcting metabolic abnormalities. Continuous renal replacement therapy provides continuous, gentle removal of fluid and solutes, which minimizes abrupt shifts in blood pressure and volume. This steadiness helps maintain organ perfusion in a patient who is vasopressor-dependent or shocky, making CRRT better tolerated than therapies that remove fluid more rapidly. Intermittent hemodialysis can cause significant hemodynamic swings during each session, risking hypotension and further compromises in perfusion. Peritoneal dialysis can be considered in certain settings, but its slower clearance and potential complications make it less ideal in this unstable, critically ill context when CRRT is available. So, the preferred approach is continuous renal replacement therapy, with intermittent hemodialysis reserved for when the patient becomes hemodynamically stable.