Peritoneal dialysis and continuous renal replacement therapy offer hemodynamic advantages in acute cardiorenal syndrome, but the scarcity of comparative studies underscores the need for randomized trials.
Could there be an advantage of a specific renal replacement modality beyond fluid removal in patients with acute cardiorenal syndrome and diuretic resistance?
There is a scarcity of comparative studies between peritoneal dialysis and continuous renal replacement therapy in acute cardiorenal syndrome with diuretic resistance, highlighting the need for randomized trials.
In cardiorenal Syndrome (CRS), diuretic resistance is frequent and congestion predominates in acute forms. In refractory cases, non-pharmacological ultrafiltration therapies have shown effectiveness on fluid removal, improved diuresis, and reduced rehospitalizations. However, the choice of modality remains individualized and resource-dependent. Both continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) offer hemodynamic advantages, but CRRT carries risks such as infection, bleeding, and high cost. PD has also demonstrated benefits in acute settings, providing effective sodium removal, and no need for anticoagulation, though it is not considered first-line therapy. There are few studies comparing different renal replacement therapies (RRT) in patients with acute CRS and there is no evidence on diuretic resistance. So, the question arises: could there be an advantage of a modality beyond fluid removal? The scarcity of comparative studies underscores the need for randomized trials that move beyond the cardiocentric perspective and include patients at risk of diuretic resistance.
Zamora-Cervantes et al. (2026) conducted a review in Acute Cardiorenal Syndrome with Diuretic Resistance. Peritoneal dialysis vs. Continuous renal replacement therapy (CRRT) was evaluated. Peritoneal dialysis and continuous renal replacement therapy offer hemodynamic advantages in acute cardiorenal syndrome, but the scarcity of comparative studies underscores the need for randomized trials.