Acute Kidney Injury — Part 4: Renal Replacement Therapy — Modalities, Timing & Prescription

RRT modalities comparison (IHD, CRRT, SLED/PIRRT), timing evidence (STARRT-AKI, AKIKI, IDEAL-ICU, ELAIN), CRRT prescription and dose, citrate and heparin anticoagulation protocols, vascular access, troubleshooting, and discontinuation criteria.

guidelinesMar 2026guidelines

1. Renal Replacement Therapy Modalities

1.1 Overview

Three broad categories of RRT are used in the ICU setting: intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and hybrid therapies (SLED/PIRRT). The choice of modality is determined by hemodynamic stability, the primary indication for RRT, institutional expertise, and resource availability.1 2

1.2 CRRT Submodes

SubmodeAbbreviationMechanismSolute RemovalFluid Used
Continuous Venovenous HemofiltrationCVVHConvection (ultrafiltration through semi-permeable membrane; solute dragged with solvent)Small and middle molecules effectively removedReplacement fluid (pre- and/or post-filter)
Continuous Venovenous HemodialysisCVVHDDiffusion (solute moves down concentration gradient across membrane)Primarily small molecules (urea, creatinine, potassium)Dialysate fluid (countercurrent flow)
Continuous Venovenous HemodiafiltrationCVVHDFCombined convection + diffusionBest overall solute clearance (small and middle molecules)Both replacement fluid AND dialysate
Slow Continuous UltrafiltrationSCUFUltrafiltration only (fluid removal without significant solute clearance)Minimal solute removalNone — isolated fluid removal

1.3 Comprehensive Modality Comparison

FeatureIHDCRRTSLED / PIRRT
Duration3-5 hours per session24 hours/day (continuous)6-12 hours per session
Blood flow rate200-400 mL/min100-250 mL/min100-300 mL/min
Dialysate flow rate500-800 mL/min1000-2500 mL/hr (17-42 mL/min)100-300 mL/min
Ultrafiltration rate1-4 L over 3-5 hours100-300 mL/hr (up to 2-3 L/day net)Variable; typically 2-4 L over session
Hemodynamic tolerancePoor — rapid fluid and solute shiftsBest — gradual, continuous removalIntermediate — better than IHD
Solute clearanceMost efficient per unit time (high diffusive clearance)Moderate, but continuous → equivalent total daily clearanceIntermediate
AnticoagulationSystemic heparin or noneRegional citrate (preferred), systemic heparin, or noneRegional citrate or systemic heparin
Nursing intensityLow (dialysis nurse present during session)High — requires continuous ICU nursing attention; frequent bag changes, monitoringModerate
CostLower (uses standard HD machine)Higher (specialized machine, disposables, replacement fluid)Intermediate (uses modified IHD machine)
Patient mobilityMobile between sessionsImmobilized during therapyMobile between sessions
Drug clearanceHigh intermittent clearance → dose after sessionModerate continuous clearance → steady-state dosingIntermediate
Ideal patientHemodynamically stable; outpatient transition; hyperkalemia emergencyHemodynamically unstable; cerebral edema; fluid overload with instability; liver failureResource-limited settings; when IHD too aggressive but CRRT unavailable or impractical
Intracranial pressure effectRisk of ICP elevation (rapid osmolality shifts — dialysis disequilibrium)Minimal ICP effect (gradual solute clearance)Intermediate

1.4 SLED / PIRRT — Hybrid Therapy

Sustained low-efficiency dialysis (SLED), also known as prolonged intermittent renal replacement therapy (PIRRT), uses a conventional IHD machine at reduced blood flow and dialysate flow rates for an extended duration (typically 6-12 hours). It offers a practical compromise between IHD and CRRT:3

  • Provides hemodynamic stability approaching CRRT
  • Uses existing IHD infrastructure (no dedicated CRRT machine required)
  • Allows daily patient mobility, imaging, and procedures during the off-therapy period
  • Increasingly used in resource-limited settings and as a transition from CRRT to IHD

2. Indications for RRT Initiation

2.1 Absolute (Emergent) Indications

The following conditions represent absolute indications for urgent RRT initiation, regardless of AKI stage or other clinical factors. These are life-threatening complications of AKI that cannot be managed with conservative measures alone:1 2

IndicationDetails
Refractory hyperkalemiaSerum potassium > 6.5 mEq/L (or any level with ECG changes) not responding to medical management (insulin/dextrose, albuterol, calcium, potassium binders)
Severe metabolic acidosispH < 7.1 or bicarbonate < 10 mEq/L refractory to sodium bicarbonate therapy; particularly if concurrent fluid overload prevents further bicarbonate infusion
Refractory fluid overloadPulmonary edema or severe volume overload not responding to diuretic therapy (including high-dose loop diuretics and combination therapy)
Uremic complicationsUremic encephalopathy (confusion, asterixis, seizures); uremic pericarditis (hemorrhagic — avoid heparin); uremic bleeding
Dialyzable toxin/ingestionMethanol, ethylene glycol, lithium, salicylate, metformin (severe lactic acidosis), theophylline, valproic acid — in context of toxic levels with clinical effects

2.2 Timing of RRT Initiation — Evidence from Landmark Trials

The optimal timing of RRT initiation in AKI without absolute indications has been one of the most debated questions in critical care nephrology. Four landmark randomized controlled trials have addressed this question:4 5 6 7

ELAIN Trial (2016)

ParameterDetails
DesignSingle-center RCT; n = 231; surgical/medical ICU patients
PopulationStage 2 AKI (by creatinine) + at least one additional indication (sepsis, fluid overload, non-renal organ failure, refractory fluid overload)
Early strategyRRT within 8 hours of Stage 2 AKI diagnosis
Delayed strategyRRT within 12 hours of Stage 3 AKI diagnosis or absolute indication
Primary outcome90-day all-cause mortality: Early 39.3% vs. Delayed 54.7% (p = 0.03) — favoring early
Secondary outcomesEarlier renal recovery (median 9 vs. 25 days, p < 0.001); shorter hospital LOS; no difference in RRT dependence at 90 days
Key limitationsSingle-center; predominantly post-surgical population; small sample size; high crossover rate in the delayed group
InterpretationThe only major trial to show a mortality benefit for early RRT; results have not been replicated in larger, multicenter trials

AKIKI Trial (2016)

ParameterDetails
DesignMulticenter RCT; n = 620; 31 French ICUs
PopulationStage 3 AKI (by creatinine or urine output) + mechanical ventilation and/or vasopressor support
Early strategyRRT initiated within 6 hours of meeting Stage 3 criteria
Delayed strategyRRT initiated only for absolute indications (refractory hyperkalemia, metabolic acidosis, pulmonary edema, BUN > 112 mg/dL, oliguria > 72 hours)
Primary outcome60-day all-cause mortality: Early 48.5% vs. Delayed 49.7% (p = 0.79) — no difference
Key secondary outcomes49% of delayed group never received RRT; catheter-related bloodstream infection higher in early group (10% vs. 5%); RRT dependence at day 60 similar
Key implicationsIn patients with Stage 3 AKI, a “watchful waiting” approach is safe; many patients recover renal function and never require RRT; early RRT exposes patients unnecessarily to RRT-related complications

IDEAL-ICU Trial (2018)

ParameterDetails
DesignMulticenter RCT; n = 488 (stopped early for futility at planned interim analysis); 29 French ICUs
PopulationSeptic shock + Failure-stage AKI (RIFLE criteria)
Early strategyRRT within 12 hours of Failure-stage AKI diagnosis
Delayed strategyRRT after 48 hours if renal recovery had not occurred, or earlier for absolute indications
Primary outcome90-day all-cause mortality: Early 58% vs. Delayed 54% (p = 0.38) — no difference; stopped early for futility
Key findings38% of delayed group never received RRT (spontaneous recovery); similar ICU and hospital LOS
Key implicationsIn septic shock with severe AKI, a 48-hour observation period is safe; early RRT does not improve outcomes and prevents many patients from avoiding RRT altogether

STARRT-AKI Trial (2020)

ParameterDetails
DesignMultinational RCT; n = 2,927 (largest trial); 168 sites across 15 countries
PopulationStage 2 or 3 AKI + at least one indication for RRT in the judgment of the treating team (but no absolute emergent indication)
Early (accelerated) strategyRRT within 12 hours of randomization
Delayed (standard) strategyRRT deferred unless: absolute indication (potassium > 6.0 despite medical therapy, pH < 7.20, PaO2/FiO2 < 200 with fluid overload, BUN > 112 mg/dL) or clinical judgment that further delay would be harmful
Primary outcome90-day all-cause mortality: Accelerated 43.9% vs. Standard 43.7% (RR 1.00; 95% CI 0.93-1.09, p = 0.92) — no difference
Key secondary outcomes61.8% of standard group received RRT (38.2% never required RRT); accelerated group had higher rates of RRT dependence at 90 days (10.4% vs. 6.0%, RR 1.74, p < 0.001); accelerated group had more adverse events related to RRT
Key implicationsDefinitive evidence against routine early RRT. No mortality benefit and potential harm (increased RRT dependence) with accelerated strategy. A “wait-and-watch” approach, initiating RRT for clinical deterioration or absolute indications, is the evidence-based standard

Summary: Timing of RRT — What the Evidence Tells Us

TrialYearnPopulationMortality DifferenceProportion of Delayed Group Avoiding RRTConclusion
ELAIN2016231Surgical, Stage 2Early better (39% vs. 55%)~10%Early benefit (but single-center, small)
AKIKI2016620MV/vasopressors, Stage 3No difference (49% vs. 50%)49%Watchful waiting safe
IDEAL-ICU2018488Septic shock, RIFLE-FNo difference (58% vs. 54%)38%Futility; early not beneficial
STARRT-AKI20202,927Stage 2-3, broad ICUNo difference (44% vs. 44%)38%Definitive: no early benefit; possible harm (RRT dependence)

Current Recommendation: For patients with AKI who do not have absolute/emergent indications for RRT, a watchful waiting strategy is recommended. RRT should be initiated when absolute indications arise or when clinical trajectory suggests inevitable need. Routine early initiation of RRT does not improve survival and may increase RRT dependence and RRT-related complications.2


3. CRRT Prescription

3.1 Dose — Effluent Rate

The prescribed CRRT dose is measured as the effluent flow rate (the sum of dialysate, replacement fluid, and net ultrafiltration) normalized to patient body weight. Two landmark trials established the current dosing standard:8 9

ATN Trial (2008)

ParameterDetails
DesignMulticenter RCT (US VA/NIH); n = 1,124
ComparisonIntensive (35 mL/kg/hr effluent for CRRT; daily IHD) vs. Less-intensive (20 mL/kg/hr effluent for CRRT; thrice-weekly IHD)
Primary outcome60-day all-cause mortality: Intensive 53.6% vs. Less-intensive 51.5% (p = 0.47) — no difference
ConclusionsHigher-intensity RRT did not improve outcomes; 20 mL/kg/hr is adequate

RENAL Trial (2009)

ParameterDetails
DesignMulticenter RCT (Australia/New Zealand); n = 1,508
ComparisonHigher-intensity CRRT (40 mL/kg/hr effluent) vs. Lower-intensity (25 mL/kg/hr effluent)
Primary outcome90-day all-cause mortality: Higher 44.7% vs. Lower 44.7% (p = 0.99) — no difference
ConclusionsNo benefit to effluent rates above 25 mL/kg/hr

Current Dosing Recommendations

ParameterRecommendationRationale
Prescribed effluent rate25-30 mL/kg/hrPrescribed dose should be 25-30 mL/kg/hr to ensure a delivered dose of 20-25 mL/kg/hr (accounting for downtime due to filter changes, procedures, imaging, etc.)
Delivered dose≥ 20 mL/kg/hr (minimum target)The effectively delivered dose is typically 10-20% less than the prescribed dose due to circuit downtime
Weight usedActual body weight (some centers use adjusted body weight for obese patients — no consensus)Dosing based on actual weight is consistent with trial methodology
Higher dosesNot routinely recommendedNo benefit in ATN or RENAL trial; may be considered in specific situations (severe sepsis, poisoning) but without strong evidence

3.2 CRRT Prescription Parameters — Complete Reference

ParameterCVVHCVVHDCVVHDFNotes
Blood flow rate (Qb)150-250 mL/min150-250 mL/min150-250 mL/minHigher blood flow reduces hemoconcentration and filter clotting risk
Replacement fluid rate25-30 mL/kg/hr (= effluent target)10-15 mL/kg/hr (convective portion)Pre-dilution reduces filter clotting but reduces solute clearance by ~15%; post-dilution maximizes clearance but increases clotting risk
Dialysate flow rate25-30 mL/kg/hr (= effluent target)10-15 mL/kg/hr (diffusive portion)Countercurrent to blood flow
Net ultrafiltration rate0-300 mL/hr (based on fluid balance target)0-300 mL/hr0-300 mL/hrDetermines net fluid removal; adjusted to target fluid balance
Pre-dilution fraction20-33% of total replacement fluidVariablePre-dilution improves filter life but requires higher total effluent to maintain delivered dose
Temperature35-37°C (fluid warmer)35-37°C35-37°CHypothermia is common with CRRT; adjust warmer settings; some centers allow mild hypothermia (35-36°C)
Filter membraneAN69, polysulfone, polyethersulfone, PMMASameSameSee Section 3.3

3.3 Filter (Membrane) Selection

Membrane TypeCharacteristicsConsiderations
PolysulfoneMost widely used; biocompatible; good solute clearance; available in multiple surface areasStandard choice for most CRRT applications
PolyethersulfoneSimilar to polysulfone; high hydraulic permeability; good biocompatibilityOften interchangeable with polysulfone
AN69 (acrylonitrile)High adsorption capacity (removes cytokines); negatively charged membraneCan cause bradykinin release (anaphylactoid reactions) in patients on ACE inhibitors — avoid in ACE inhibitor patients; good for sepsis (cytokine adsorption)
PMMA (polymethyl methacrylate)High cytokine adsorption; used primarily in JapanLess widely available; studied for sepsis-associated AKI

Surface area selection:

Patient WeightRecommended Surface Area
< 60 kg0.6-1.0 m²
60-90 kg1.0-1.5 m²
> 90 kg1.5-2.0 m²

3.4 Dialysate and Replacement Fluid Composition

Standard commercially available CRRT solutions have the following composition (approximate — varies by manufacturer):1

ComponentTypical ConcentrationNotes
Sodium140 mEq/LCan be customized for hyper- or hyponatremia management
Potassium0 or 4 mEq/LUse K+ = 0 solution for hyperkalemia; K+ = 4 for normokalemia; may need to add KCl to bags for hypokalemia
Calcium0 (if citrate anticoagulation) or 3.0-3.5 mEq/L (if non-citrate)Calcium-free solutions required for citrate anticoagulation (see Section 4.1)
Magnesium1.0-1.5 mEq/LMonitor closely; supplementation often needed
Chloride108-113 mEq/L
Bicarbonate22-35 mEq/LPrimary buffer in most solutions; can be customized to correct acidosis
Lactate0-40 mEq/L (some solutions use lactate instead of bicarbonate)Lactate is metabolized to bicarbonate; avoid lactate-buffered solutions in liver failure (impaired lactate clearance → lactic acidosis confusion)
Glucose0-110 mg/dLGlucose-free solutions may cause hypoglycemia; monitor glucose q4-6h
Phosphate0 (most solutions) or 1.0-1.2 mmol/L (phosphate-containing solutions)Hypophosphatemia is extremely common with CRRT (> 60% of patients); phosphate-containing solutions reduce this complication; otherwise, IV phosphate supplementation is required

4. Anticoagulation for CRRT

4.1 Regional Citrate Anticoagulation (RCA) — Preferred Method

Regional citrate anticoagulation is the recommended first-line anticoagulation method for CRRT based on superior filter life and lower bleeding risk compared to systemic heparin.1 10 11

Mechanism

Citrate (as trisodium citrate or anticoagulant citrate dextrose — ACD-A) is infused into the CRRT circuit pre-filter, where it chelates ionized calcium. Since calcium (Factor IV) is an essential cofactor in the coagulation cascade, reducing ionized calcium in the circuit to < 0.35 mmol/L effectively prevents clotting within the filter. The citrate-calcium complex is partially removed by the filter (dialysate/effluent). The remaining citrate enters the patient’s systemic circulation, where it is rapidly metabolized by the liver and muscle (Krebs cycle) to bicarbonate. Systemic calcium is maintained by a separate calcium chloride or calcium gluconate infusion.

Citrate Anticoagulation Protocol

ParameterTarget / DoseMonitoring
Citrate solutionACD-A (2.2% citrate) or 4% trisodium citrateFlow rate titrated to circuit ionized calcium target
Citrate infusion rateInitial: 1.5-2.5 mmol citrate per liter of blood flow (adjust based on circuit iCa)
Circuit (post-filter) ionized calcium0.25-0.35 mmol/LMeasure q2-4 hours from post-filter port; adjust citrate dose up/down
Systemic ionized calcium1.0-1.2 mmol/L (normal range)Measure q4-6 hours from patient’s arterial line or venous blood; adjust calcium replacement infusion
Calcium replacement infusionCalcium chloride 10% at 1-4 mL/hr via central line OR calcium gluconate 10% at 3-12 mL/hr via central or peripheral lineTitrate to systemic iCa target
Dialysate/replacement fluidMust be calcium-free (0 Ca²⁺)Standard citrate-compatible solutions
Total calcium : ionized calcium ratio< 2.5If ratio > 2.5, suspect citrate accumulation (see below)

Citrate Accumulation — Recognition and Management

Citrate accumulation occurs when the liver or muscle cannot metabolize citrate adequately (liver failure, shock with tissue hypoperfusion, massive transfusion). The accumulated citrate continues to chelate calcium, producing a characteristic pattern:11

SignExplanation
Falling systemic ionized calcium (despite increasing calcium replacement)Citrate chelates calcium; unmetabolized citrate continues to bind calcium
Rising total calciumCitrate-calcium complexes are measured as “total calcium”
Total calcium : ionized calcium ratio > 2.5Hallmark of citrate accumulation; “calcium gap”
Metabolic acidosis (sometimes with elevated anion gap)Failure to metabolize citrate to bicarbonate; citrate itself is an unmeasured anion
Worsening metabolic alkalosis (paradoxically, if partial metabolism occurs)Each citrate molecule metabolized generates 3 bicarbonate molecules; in partial accumulation, enough citrate is metabolized to cause alkalosis

Management of citrate accumulation:

  1. Reduce citrate infusion rate by 25-50%
  2. Increase calcium replacement infusion to maintain systemic iCa > 1.0 mmol/L
  3. If severe (total:ionized Ca ratio > 2.5 with clinical instability): switch to heparin anticoagulation or no anticoagulation
  4. Consider reducing CRRT blood flow rate (which proportionally reduces citrate delivery to the patient)

Contraindications to Citrate Anticoagulation

ContraindicationReason
Severe liver failure (acute or decompensated cirrhosis)Impaired citrate metabolism → accumulation risk
Severe shock with lactic acidosis (lactate > 4-6 mmol/L persistently)Impaired tissue perfusion → reduced citrate metabolism
Massive transfusion (citrate in blood products adds to citrate load)Combined citrate load may overwhelm metabolic capacity

Note: Relative contraindications require careful clinical judgment. Many centers successfully use citrate anticoagulation in patients with moderate liver dysfunction with close monitoring of the total:ionized calcium ratio.

4.2 Systemic Heparin Anticoagulation

Systemic unfractionated heparin (UFH) is the alternative when citrate is contraindicated or unavailable.1

ParameterProtocol
Loading dose1,000-2,000 units IV bolus into circuit (or no bolus if high bleeding risk)
Maintenance5-15 units/kg/hr (typically 500-1,500 units/hr) via infusion pump into arterial limb of circuit
MonitoringaPTT q4-6 hours (target 45-60 seconds, or 1.5-2x control); or anti-Xa level (target 0.3-0.5 IU/mL)
AdvantagesSimple; no specialized solutions required; familiar to all staff
DisadvantagesSystemic anticoagulation → increased bleeding risk; shorter filter life compared to citrate (median 17-24 hrs vs. 40-70 hrs with citrate); HIT risk

4.3 No Anticoagulation

Running CRRT without anticoagulation is appropriate in selected situations:1

Indication for No AnticoagulationStrategy
Active bleedingNo anticoagulation; accept shorter filter life; use pre-dilution (30-50% of replacement fluid) to reduce hemoconcentration; higher blood flow rates (200-250 mL/min)
Coagulopathy (INR > 2.0, platelets < 50,000)Endogenous coagulopathy provides some anticoagulation; pre-dilution helpful
Uremic pericarditisHeparin contraindicated (hemorrhagic pericarditis risk); citrate preferred if available; otherwise no anticoagulation
Post-operative with high bleeding riskAssess risk-benefit; pre-dilution and intermittent saline flushes (100-200 mL q30-60min) may extend filter life

Practical Tip: When running without anticoagulation, periodic saline flushes (100-200 mL of normal saline pushed through the circuit every 30-60 minutes) and pre-dilution replacement fluid can extend filter life to 12-24 hours in many cases.


5. Vascular Access for RRT

5.1 Catheter Selection

Non-tunneled, dual-lumen hemodialysis catheters are used for acute RRT in the ICU. Catheter choice and insertion site significantly affect RRT efficacy and complication rates.1 12

Insertion SiteCatheter LengthBlood Flow RateAdvantagesDisadvantages
Right internal jugular vein (preferred)15 cm (13.5-16 cm)250-400 mL/minStraight path to SVC-RA junction; best flow rates; lowest malposition rate; lowest recirculationNeck movement may be restricted; risk of carotid puncture
Left internal jugular vein20 cm (19-24 cm)200-350 mL/minAcceptable alternativeLonger catheter → more resistance; higher malposition rate; must cross brachiocephalic vein → higher risk of stenosis
Femoral vein24 cm (20-25 cm minimum)200-350 mL/minNo pneumothorax risk; easy insertion; no interference with TTE/TEEHigher infection rate; immobilizes patient; tip must reach IVC (short catheters have high recirculation); thrombosis risk
Subclavian vein15-20 cm (right), 20 cm (left)200-350 mL/minMost comfortable for patient; lowest infection rateHighest risk of subclavian stenosis — may preclude future AV fistula creation; pneumothorax risk; difficult to compress if bleeding

Key Recommendation: The right internal jugular vein is the preferred site for RRT catheter placement. Avoid subclavian vein catheterization in patients with AKI who may progress to CKD and eventually require permanent dialysis access — subclavian stenosis can preclude ipsilateral AV fistula or graft creation.12

5.2 Catheter Specifications

ParameterRecommendation
Lumen size12-14 French (dual lumen) for adequate flow
Tip designSplit-tip (Ash Split Cath) or staggered-tip designs may reduce recirculation
ConfirmationCXR for IJ and subclavian (confirm tip at SVC-RA junction, rule out pneumothorax); ultrasound-guided insertion reduces complications
Locking solutionHeparin (1,000-5,000 units/mL) or 4% citrate in each lumen when not in use

6. CRRT Troubleshooting

6.1 Filter Clotting

Filter clotting is the most common reason for CRRT circuit interruption, reducing delivered dose and increasing costs.1

CauseIdentificationSolution
Inadequate anticoagulationRising transmembrane pressure (TMP); dark blood in filterIncrease citrate dose (target circuit iCa 0.25-0.35); increase heparin dose; consider pre-dilution
Hemoconcentration (filtration fraction > 20-25%)High filtration fraction = (ultrafiltration rate + replacement fluid rate) / (plasma flow rate)Increase blood flow rate; add pre-dilution; reduce net ultrafiltration rate
Low blood flow rateQb < 150 mL/min consistentlyCheck catheter function; reposition patient; assess for catheter malposition or thrombus; consider catheter exchange
Catheter dysfunctionFrequent access and return pressure alarms; inability to achieve target QbTPA lock (2 mg per lumen, dwell 30-60 min); consider catheter exchange over wire or at new site
Blood product administration through circuitPlatelets and RBCs activate coagulation in circuitAdminister blood products through a separate IV line, not the CRRT circuit

Filtration fraction calculation and target:

FF = (Quf + Qreplacement_post) / (Qplasma) × 100

Where Qplasma = Qb × (1 - Hct)

Target: FF < 20-25% — higher filtration fractions increase hemoconcentration and clotting risk.

6.2 Hemodynamic Instability During CRRT

CauseManagement
Excessive ultrafiltration rateReduce net UF rate; reassess fluid removal goals
Rapid solute shifts (uncommon with CRRT, more with IHD)Reduce dialysate flow rate
Blood loss into circuit (with each filter change, 150-250 mL of blood is lost if not returned)Return blood in circuit before filter change when possible; monitor hemoglobin
HypothermiaIncrease fluid warmer temperature; consider heated blankets
Membrane bioincompatibilityRare; consider alternative membrane type

6.3 Electrolyte Derangements During CRRT

DerangementCausePrevention / Management
HypophosphatemiaCRRT efficiently clears phosphate; most standard CRRT solutions contain no phosphateUse phosphate-containing CRRT solutions; IV sodium/potassium phosphate supplementation (20-40 mmol/day); monitor phosphate q6-8h; the most common electrolyte complication of CRRT
HypokalemiaEfficient potassium clearance; especially with K+ = 0 solutionsSwitch to K+ = 4 mEq/L solutions when potassium normalized; IV KCl supplementation; monitor q4-6h
HypomagnesemiaMagnesium cleared by CRRTIV magnesium supplementation (2-4 g/day); monitor q8-12h
HypocalcemiaCitrate anticoagulation; CRRT clearanceCalcium replacement infusion (with citrate); monitor iCa q4-6h
Metabolic alkalosisExcessive bicarbonate delivery from CRRT solutions; citrate metabolism generates bicarbonateReduce bicarbonate concentration in solutions; reduce citrate dose if able; consider switching to lower-bicarbonate solutions
HypothermiaHeat loss from extracorporeal circuitFluid warmer; heated blankets; monitor core temperature

6.4 Drug Clearance by CRRT

Drugs are removed by CRRT based on molecular weight, protein binding, and volume of distribution:13

FactorEffect on CRRT ClearanceExamples
Low molecular weight (< 500 Da)High clearanceVancomycin, aminoglycosides, beta-lactams
Low protein binding (< 80%)High clearanceAminoglycosides, fluconazole, acyclovir
Small volume of distribution (< 1 L/kg)Higher drug concentration in blood → more removedAminoglycosides
High molecular weight (> 20,000 Da)Minimal clearanceDaptomycin (partially), heparin
High protein binding (> 80%)Minimal clearanceCeftriaxone, phenytoin, warfarin
Large volume of distribution (> 2 L/kg)Minimal impact of CRRT clearanceDigoxin, amiodarone

7. IHD Prescription in the ICU

7.1 When to Prefer IHD Over CRRT

IndicationRationale
Hemodynamically stable patientIHD is more efficient and less resource-intensive
Life-threatening hyperkalemia (requiring emergent potassium removal)IHD provides more rapid potassium clearance than CRRT
Dialyzable poisoning (methanol, ethylene glycol, lithium, salicylate)High blood and dialysate flow rates maximize toxin removal; may require extended IHD (8-12 hours)
Transition from CRRT (improving hemodynamics)Step-down from CRRT to IHD as patient stabilizes
Resource constraintsIHD requires less nursing intensity and lower consumable costs

7.2 IHD Prescription Parameters

ParameterRecommended Range
Blood flow rate (Qb)200-300 mL/min (start lower in hemodynamically fragile patients; 150-200 mL/min)
Dialysate flow rate (Qd)500-800 mL/min
Session duration3-4 hours (first session: 2 hours to avoid dialysis disequilibrium; extend gradually)
FrequencyDaily or alternate-day, based on clinical needs
UltrafiltrationLimit to ≤ 10-13 mL/kg/hr to minimize hemodynamic instability; total UF based on fluid overload and hemodynamic tolerance
Dialysate compositionSodium 140 mEq/L, potassium 2-4 mEq/L, calcium 2.5-3.0 mEq/L, bicarbonate 35-40 mEq/L
DialyzerHigh-flux polysulfone membrane; appropriate surface area for patient size
AnticoagulationSystemic heparin (1,000-2,000 units bolus, then 500-1,000 units/hr); or no anticoagulation if bleeding risk

8. RRT Discontinuation Criteria

8.1 When to Attempt Discontinuation

There is no universally accepted protocol for RRT discontinuation. The decision is guided by evidence of renal recovery:1 2 14

CriterionThreshold Suggesting Recovery
Spontaneous urine output≥ 400-500 mL/24 hours (without diuretics) OR ≥ 1,000-2,000 mL/24 hours (with diuretics)
Creatinine clearanceMeasured 6- or 24-hour creatinine clearance > 15-20 mL/min
Resolution of indicationHyperkalemia controlled; acidosis corrected; fluid balance manageable without RRT
Furosemide stress test responseUrine output > 200 mL in 2 hours after 1.0-1.5 mg/kg furosemide
Negative fluid balance achievableAble to achieve target fluid balance with diuretics alone

8.2 Practical Approach

  1. Assess daily whether RRT can be discontinued
  2. Reduce CRRT dose before stopping (some centers reduce effluent rate to 15 mL/kg/hr for 6-12 hours as a “wean”)
  3. Monitor closely for 48-72 hours after discontinuation: electrolytes q6-8h, urine output hourly, creatinine daily
  4. Restart RRT if absolute indications recur or if creatinine rises rapidly without adequate urine output
  5. Expect: 10-20% of patients who discontinue RRT will need to be restarted within 72 hours

References


  1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. “KDIGO Clinical Practice Guideline for Acute Kidney Injury.” Kidney Int Suppl. 2012;2(1):1-138. DOI: 10.1038/kisup.2012.1 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

  2. Ostermann M, Bellomo R, Burdmann EA, et al. “Controversies in Acute Kidney Injury: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference.” Kidney Int. 2020;98(2):294-309. DOI: 10.1016/j.kint.2020.04.020 ↩︎ ↩︎ ↩︎ ↩︎

  3. Marshall MR, Ma T, Galler D, et al. “Sustained Low-Efficiency Dialysis for Critically Ill Patients Requiring Renal Replacement Therapy.” Kidney Int. 2001;60(2):777-785. DOI: 10.1046/j.1523-1755.2001.060002777.x ↩︎

  4. Bagshaw SM, Wald R, Adhikari NKJ, et al. “Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI).” N Engl J Med. 2020;383(3):240-251. DOI: 10.1056/NEJMoa2000741 ↩︎

  5. Gaudry S, Hajage D, Schortgen F, et al. “Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit (AKIKI).” N Engl J Med. 2016;375(2):122-133. DOI: 10.1056/NEJMoa1603017 ↩︎

  6. Barbar SD, Clere-Jehl R, Bourredjem A, et al. “Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis (IDEAL-ICU).” N Engl J Med. 2018;379(15):1431-1442. DOI: 10.1056/NEJMoa1803213 ↩︎

  7. Zarbock A, Kellum JA, Schmidt C, et al. “Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial.” JAMA. 2016;315(20):2190-2199. DOI: 10.1001/jama.2016.5828 ↩︎

  8. VA/NIH Acute Renal Failure Trial Network; Palevsky PM, Zhang JH, O’Connor TZ, et al. “Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury.” N Engl J Med. 2008;359(1):7-20. DOI: 10.1056/NEJMoa0802639 ↩︎

  9. RENAL Replacement Therapy Study Investigators; Bellomo R, Cass A, Cole L, et al. “Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients.” N Engl J Med. 2009;361(17):1627-1638. DOI: 10.1056/NEJMoa0902413 ↩︎

  10. Oudemans-van Straaten HM, Bosman RJ, Koopmans M, et al. “Citrate Anticoagulation for Continuous Venovenous Hemofiltration.” Crit Care Med. 2009;37(2):545-552. DOI: 10.1097/CCM.0b013e3181953c5e ↩︎

  11. Slowinski T, Morgera S, Joannidis M, et al. “Safety and Efficacy of Regional Citrate Anticoagulation in Continuous Venovenous Hemodialysis in the Presence of Liver Failure: The Liver Citrate Anticoagulation Threshold (L-CAT) Observational Study.” Crit Care. 2015;19(1):349. DOI: 10.1186/s13054-015-1066-7 ↩︎ ↩︎

  12. Vascular Access Work Group. “Clinical Practice Guidelines for Vascular Access.” Am J Kidney Dis. 2006;48(Suppl 1):S176-S247. DOI: 10.1053/j.ajkd.2006.04.029 ↩︎ ↩︎

  13. Seyler L, Cotton F, Taccone FS, et al. “Recommended Beta-Lactam Regimens Are Inadequate in Septic Patients Treated with Continuous Renal Replacement Therapy.” Crit Care. 2011;15(3):R137. DOI: 10.1186/cc10257 ↩︎

  14. Uchino S, Bellomo R, Morimatsu H, et al. “Discontinuation of Continuous Renal Replacement Therapy: A Post Hoc Analysis of a Prospective Multicenter Observational Study.” Crit Care Med. 2009;37(9):2576-2582. DOI: 10.1097/CCM.0b013e3181a38241 ↩︎