Continuous Renal Replacement Therapy (CRRT)
- 1. Urgent indications for Continuous Renal Replacement Therapy in patients with Acute Kidney Injury include volume overload refractory to diuretics, hyperkalemia, metabolic acidosis, uremia, and toxic overdose of a dialyzable drug. It is preferable that Continuous Renal Replacement Therapy be electively initiated prior to the development of urgent indications.
- 2. Continuous Renal Replacement Therapy should be used for hemodynamically unstable patients rather that standard intermittent hemodialysis. Also, it should be used for Acute Kidney Injury patients with acute brain injury or other causes of increased intracranial pressure or generalized brain edema.
- 3. For anticoagulation in CRRT, regional citrate anticoagulation is preferable to heparin.
- 4. CRRT should be provided with a delivered effluent flow rate of ≥20 mL/kg per hour, and in order to ensure delivery of this flow rate, the prescribed flow rate should be ≥25 mL/kg per hour. The CRRT delivered dose should be measured.
- 5. CRRT should be discontinued when it is no longer required because kidney function has recovered to the point that is adequate to meet the patient’s needs; a measured creatinine clearance >20 mL/min should allow the discontinuation of CRRT.
