Continuous renal replacement therapy (CRRT) delivers gradual clearance of solutes, fluid balance control, and haemodynamic stability. CRRT does not appear to increase survival compared to intermittent renal replacement therapy (IRRT), but may affect renal recovery.

Early CRRT initiation may not improve outcomes, and the definition of “early” varies between studies. Therefore, clinical judgement guides CRRT initiation. We aim to prevent or rapidly treat life-threatening derangements in fluid status, electrolytes, and/or acid–base balance and to meet metabolic and fluid needs that residual kidney function cannot address.

We prefer CVVHDF with regional citrate anticoagulation via a triple lumen catheter inserted into the right internal jugular vein or the right femoral vein.

Timing of initiation and cessation of CRRT is based on clinical judgement. We prescribe a blood flow rate of 120 mL/min and an effluent flow rate of 25 mL/kg/h with citrate anticoagulation.

We avoid aggressive NUF unless clinically indicated. We adjust effluent flow rate for specific patients to target ammonia clearance.

We monitor the safety and quality of CRRT and advocate for the use of protocolised care.

Although intensivists prescribe CRRT in our unit, we acknowledge that collaborative and multidisciplinary prescription is common worldwide.

Read More