Continuous Renal Replacement Therapy Does Not Have a Clear Role in the Treatment of Poisoning

Extracorporeal removal of drugs and other poisons is occasionally indicated in the management of intoxications. The available modalities include hemodialysis and several methods of continuous renal replacement therapy (CRRT), including continuous venovenous hemofiltration with or without dialysis augmenting drug removal. A growing literature promoting CRRT for extracorporeal removal has been published and is reviewed here. Estimates of clearance achieved by these techniques uniformly demonstrate that hemodialysis achieves higher clearances. CRRT may be appropriate for more hypotensive and unstable patients, though these might be the patients most in need of a more rapidly effective technique. For the most part, these case reports have not demonstrated that CRRT was necessary because of hemodynamic instability. Hemodialysis remains the first choice among modalities of extracorporeal removal with CRRT reserved for patients who truly cannot tolerate hemodialysis.