Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy

Ashita J. Tolwani

Phuong-Chi T. Pham


  • Continuous renal replacement therapy (CRRT) is beneficial for hemodynamically unstable patients and generally provides better volume control than intermittent hemodialysis (IHD) in critically ill unstable patients with acute kidney injury (AKI).

  • CRRT provides better hemodynamic stability due to slower volume removal and solute removal per unit time as compared to IHD.

  • Observational studies demonstrate a trend for improved renal recovery with CRRT compared to IHD, but randomized controlled trials (RCTs) have not shown this.

  • Randomized studies have not shown a survival benefit with CRRT as compared to IHD.


  • CRRT is preferred in patients with acute liver failure, cardiogenic shock, septic shock, and multiorgan failure.

Indications for CRRT in patients with kidney failure include the following

  • Need for continuous solute control (e.g., tumor lysis syndrome, rhabdomyolysis)

  • Need for continuous volume control (e.g., heart failure, acute respiratory distress syndrome)

  • Increased intracranial pressure (ICP)

  • Slow correction of severe dysnatremias

  • High risk of osmotic disequilibrium with IHD

Disadvantages of CRRT compared with IHD

  • Intensive care unit (ICU) level care

  • Slower removal of toxins (which means that CRRT is not the RRT of choice for drug intoxications or severe hyperkalemia)

  • Patient immobility

  • Anticoagulation is often needed.

  • Hypothermia

  • Nutritional losses

  • Increased drug clearance with difficulty in dosing medications

  • Increased cost


  • The optimal timing of RRT initiation remains undefined.

  • A 2019 meta-analysis on the timing of initiation of RRT in AKI involving 18 RCTs from 1997 to 2018, n = 2,856, showed no significant difference in mortality between early initiation and delayed initiation of RRT in both critically ill and community-acquired AKI patients, as well as in a subgroup of patients with sepsis and in cardiac surgery recipients. An early RRT strategy was associated with a significantly higher incidence of the need for RRT for AKI patients (relative risk [RR] 1.24, 95% confidence interval [CI]: 1.13 to 1.36, p < 0.01). That is, delayed start avoided RRT altogether in some patients because they were allowed the time to recover adequate kidney function (Yi L et al. Med (Baltimore)).

Jul 21, 2021 | Posted by in NEPHROLOGY | Comments Off on Continuous Renal Replacement Therapy

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