HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

CONTINUOUS RENAL REPLACEMENT THERAPY

Duygu Kayar Çalılı1,2

1Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Anesthesiology and Reanimation;
2 Ankara City Hospital, Department of Intensive Care, Ankara, Türkiye

Kayar Çalılı D. Continuous Renal Replacement Therapy. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.71-80.

ABSTRACT

Continuous renal replacement therapy (CRRT) is preferred in critically ill patients with acute kid ney injury and hemodynamic instability, including those in shock or with brain injury. Continuous venovenous hemodialysis, continuous venovenous hemofiltration, and continuous venovenous hemo diafiltration are the primary CRRT modalities. Treatment modality selection is based on the primary goal, accessibility of the therapy, and the experience of the healthcare team. Individualized patient management is crucial in CRRT, requiring continuous assessment and adjustment of treatment param eters based on the patient’s clinical status and response to therapy. The requirement for anticoagulation to maintain circuit patency represents a significant disadvantage of CRRT; regional citrate anticoagu lation is generally recommended, even in patients without a bleeding risk. However, in patients with severe coagulopathy or active bleeding, anticoagulationfree CRRT may be considered. The absence of anticoagulation is associated with an increased risk of circuit clotting, blood loss, and treatment failure. During CRRT, close monitoring of the patient’s hemodynamics, electrolytes, acidbase balance, and lactate levels is essential. Dose adjustments should be made for medications whose pharmacokinetics and clearance may be altered to avoid decreased efficacy or toxicity. Careful attention should be paid to vascular accessrelated complications, hemodynamic instability, metabolic disturbances, hematologic abnormalities and nutritional deficiencies. To minimize complications during CRRT, catheter care, cir cuit integrity, and machine alarms should be closely monitored. Furthermore, a welltrained and expe rienced healthcare team is crucial for the successful implementation of CRRT. Disadvantages of CRRT other than anticoagulation include slow toxin clearance, membrane absorption and immobilization. Successful implementation requires a multidisciplinary team with expertise in physiology, equipment, and patient care, as well as strong monitoring skills because CRRT is a complex procedure that can last for days. CRRT can be terminated when renal function improves, as evidenced by increased urine output and a decreasing creatinine level.

Keywords: Critical care; Acute kidney injury; Continuous renal replacement therapy; Hemofiltration; Citrates

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