Continuous Renal Replacement Therapy for Acute Kidney Injury

Introduction to CRRT Modalities

• The Kidney International society recommends continuous venovenous hemodiafiltration (CVVHDF) as the primary CRRT modality for patients with acute kidney injury, particularly for hemodynamically unstable patients, with modality selection tailored to the patient's clinical condition, institutional expertise, and available resources 1, 2

Patient-Specific CRRT Modality Selection

• The Kidney International society recommends CVVHDF or CVVH for hemodynamically unstable patients requiring vasopressor support 2, 4
• The Kidney International society recommends CVVHDF or CVVH for patients with acute brain injury or increased intracranial pressure 4, 5
• The Kidney International society recommends CVVHDF or CVVH for patients with severe fluid overload that cannot be managed with intermittent modalities 2, 4
• The Kidney International society recommends CVVHDF or CVVH for patients on extracorporeal life support (ECLS) such as ECMO 1, 6, 4

Technical Considerations

• The Kidney International society recommends delivering an effluent volume of 20-25 mL/kg/h for all CRRT modalities 1, 2
• The Kidney International society recommends using bicarbonate-based replacement fluids rather than lactate-based solutions, especially in patients with shock, liver failure, or lactic acidemia 3, 5
• The Kidney International society recommends regional citrate anticoagulation for patients without contraindications 2, 5

Vascular Access for CRRT

• The Kidney International society recommends the right jugular vein or femoral vein as the first choice for vascular access, with the femoral site being inferior in patients with increased body mass 1, 2, 5
• The Kidney International society recommends the left jugular vein as the second choice for vascular access 1, 2, 5
• The Kidney International society recommends avoiding the subclavian vein due to the risk of thrombosis and stenosis 1, 5

Dosing Recommendations

• The Kidney International society recommends delivering an effluent volume of 20-25 mL/kg/h for all CRRT modalities 1, 2

Special Considerations

• The Kidney International society recommends CRRT for patients requiring ECMO or other extracorporeal life support to prevent and manage fluid overload 6, 4
• The Kidney International society states that the selection of RRT modality does not appear to have a major impact on recovery of kidney function 1, 6