Continuous Renal Replacement Therapy

Abstract

Continuous renal replacement therapy (CRRT) is commonly used for acute kidney injury (AKI) in intensive care units (ICU) for renal support, especially in hemodynamically unstable patients in much of the developed world. However, despite its widespread use, there is no formal evidence regarding the improvement in patient related outcomes when CRRT is used instead of intermittent hemodialysis (IHD). Various techniques can be used that differ in the mode of solute removal, including continuous venous hemofiltration with primarily convective solute removal, continuous venous hemodialysis with primarily diffusional solute removal, and continuous venous hemodiafiltration, which is a combination of both dialysis and hemofiltration methods. In this review, we compare CRRT with other renal support modalities and examine the indications for initiation of renal replacement therapy, as well as dosage and technical considerations for administering CRRT. We also describe some of the controversies and questions that remain to be answered regarding the use of CRRT.