Extracorporeal elimination of drugs and toxins is a critical component in the management of
poisonings, though specific techniques and indications remain a matter of debate. Conventional
hemodialysis is frequently the treatment of choice because of its widespread availability and proven effectiveness for certain drugs and toxins. With the increased availability of
continuous renal replacement therapy (CRRT) modalities, there is yet another therapeutic option, but one that has yet to find a definitive role in this field. The continuous nature of these
therapies is attractive for the management of
acute renal failure, but the relatively slower clearance rates as compared to conventional
hemodialysis is a distinct drawback in patients with acute
xenobiotic-induced toxicity. There are abundant case reports as well as a few small case series in the medical literature documenting the use of CRRT, but specific techniques and the clinical outcomes vary considerably. Therefore one cannot draw definitive conclusions regarding benefit. Some patients, particularly those who are hemodynamically unstable and are not candidates for conventional
hemodialysis, may warrant a trial of CRRT. However, at the present time, routine use for the treatment of
poisoning is not supported. Controlled trials to better clarify its role would be beneficial, though such studies would be extremely difficult to conduct in this field. We believe that the intelligent application of extracorporeal modalities requires a thorough knowledge of
drug pharmacokinetics, of the techniques utilized, and a skeptical analysis of the available literature.