Continuous Renal Replacement Therapy CRRT – Part 1
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Continuous Renal Replacement Therapy (CRRT) – Part 1
By Celia Bradford
Acute kidney injuries are a significant cause of morbidity and mortality in the ICU setting. 5-6% of patients progress to needing continuous renal replacement therapy which has an associated 80% mortality rate.
One of the biggest issues with CRRT is deciding on when to commence CRRT. One tool to assist with determining the severity of an AKI and therefore the decision to dialyse is the RIFLE classification. The RIFLE classification for defining AKI and is a system devised by nephrologists and intensivist in 2002. It stands for Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease. Progression down the criteria is associated with increased length of stay in ICU and hospital, increased mortality and lower renal recovery.
This presentation is the first in a series of 4 about CRRT. Dr Celia Bradford (@celiabradford) provides and excellent, easy to follow introduction to using CRRT in the ICU setting. This short presentation offers excellent insight into the basics of physiology, vascular access, indications, pharmacology, dose and prescription of dialysis.
As the name suggests, CRRT is essentially a means of replacing the lost function of kidneys in the setting of an acute kidney injury. It is a means of waste management and fluid management in acutely unwell patients. In this presentation, Dr Bradford outlines the principles CRRT including circuit structure, haemofiltration and haemodialysis. She describes the possible variations in setting up the CRRT and how these affect dialysis. She also outlines the different sites for vascular access as per the KDIGO guidelines including pros and cons for each site before briefly outlining indications, adverse effects, dosage and prescription of dialysis.