Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

• Published in: Kidney medicine Vol. 3; no. 5; pp. 827 - 836
• Main Authors: Verma, Siddharth, Palevsky, Paul M.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021; Elsevier
• Subjects: Acute Kidney Injury; continuous kidney replacement therapy; Continuous renal replacement therapy; continuous venovenous hemodiafiltration; continuous venovenous hemodialysis; continuous venovenous hemofiltration; hemodiafiltration; hemodialysis; hemofiltration; Review; ultrafiltration; continuous venovenous hemodialysis; Acute Kidney Injury; continuous venovenous hemofiltration; continuous kidney replacement therapy; hemodialysis; continuous venovenous hemodiafiltration; hemofiltration; ultrafiltration; Continuous renal replacement therapy; hemodiafiltration
• ISSN: 2590-0595; 2590-0595
• DOI: 10.1016/j.xkme.2021.05.006

Severe acute kidney injury is a common complication in critically ill patients, often necessitating support with a modality of kidney replacement therapy. Continuous kidney replacement therapies (CKRTs) have become a mainstay in the management of patients with acute kidney injury in the intensive care unit. Understanding the fundamentals of CKRT is necessary to safely and effectively prescribe treatment. In this narrative review, we summarize critical aspects of CKRT management, including selection of the mode of therapy; choice of hemofilter/hemodialyzer used; determination of the blood flow rate, composition and flow rates of dialysate and/or replacement fluids, and the ultrafiltration rate; and use and methods of anticoagulation. Requirements for vascular access and appropriate monitoring and dose adjustment of medications and a plan for monitoring the delivery of therapy and ensuring appropriate nutritional management are also discussed.