CRRT

Continuous renal replacement therapy (CRRT) is any extracorporeal blood purification therapy designed to substitute for impaired renal function over an extended period, and intended to be applied for up to 24 hours a day.(1)

As the body of scientific studies on CRRT increase, more and more clinicians are coming to agreement that CRRT is the modality of choice for treating ICU patients with Acute Kidney Injury (AKI), especially in the case of hemodynamically unstable AKI patients.

Benefits of CRRT

Short-term benefits

  • Supports the renal system through continuous, gentle removal of excess metabolic waste products, while returning normal electrolyte and acid/base balance.
  • Restores and maintains net neutral fluid balance (prevents accumulation that leads to fluid overload).
  • Delivers continuous nutritional support without concern for fluid restrictions.
  • Provides for optimized drug dosing.

Long-term benefits

  • May improve patient survival rates.2 A 55% survival rate was realized in the largest randomized control trial to date.
  • May increase renal recovery, defined as freedom from dialysis dependence. A 94% recovery rate was achieved in the same large randomized control trial noted above.
  • May result in a higher rate of renal recovery when compared to conventional hemodialysis after AKI, as indicated by multiple large clinical studies.

Today, nephrologists are prescribing CRRT with an increasing level of confidence due to its short- and long-term benefits, and studies that support its success in treating critically ill AKI patients who are hemodynamically unstable.

Examples of CRRT treatments include:

  • SCUF - slow continuous ultrafiltration is intended to remove excess fluid.
  • CVVH – continuous veno-venous hemofiltration strives to provide convective clearance of excess waste products; middle/large molecules; balance of electrolytes, acid/base and excess fluid.
  • CVVHD – continuous veno-venous hemodialysis can deliver diffusive clearance of excess waste products; small molecules; balance of electrolytes, acid/base and excess fluid.
  • CVVHDF – continuous veno-venous hemodiafiltration aims to provide diffusive clearance of excess waste products; small molecules; removal of middle/large molecules; balance of electrolytes, acid/base and excess fluid.
  • Hemoadsorption - an extracorporeal blood purification technique that provides removal of target substances from the blood by adsorption of the target substances to a sorbent cartridge/filter. 

 

(1) Kellum, Bellomo, Ronco. Continuous Renal Replacement Therapy. New York: Oxford University Press, 2010, print.

(2) RENAL: Randomized Evaluation of Normal versus Augmented Level of renal replacement. Bellomo et all, Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients. N Engl J Med 2009;361:1627-38.

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