Principles of Continuous Renal Replacement Therapy

Dr. Deborah Stein returns for another core content lecture, this time giving a crash course on hemodialysis, CRRT, CVVH, CVVHD, and a number of other concepts about managing acute renal failure in the ICU.  For this lecture, Dr. Stein went “old school” and brought us back to the greaseboard.  This is a must watch primer on renal replacement therapy – something encountered every day in the ICU.  Check out her drawing skills and more below in this week’s core content lecture.

STC – CRRT Cheat Sheet.pdf

Key Variable Definitions

  • QB = Blood flow rate through the filter (mL/min)
  • QUF = Ultrafiltration rate (mL/hour) also known as “PFR – Patient Fluid Removal” when using Gambro pumps
  • QD = Dialysate flow rate (L/hour)
  • QSF = Rate of fluid given to the patient pre- or post- filter (L/hour)

Pearls

  1. There is no definitive evidence that continuous renal replacement therapy (CRRT) improved morbidity or mortality over intermittent hemodialysis (IHD).  However, many studies comparing the two have excluded hemodynamically unstable patients.
  2. Choose CRRT over IHD for patients with severe rhabdomyolysis and acute renal failure because the IHD filters will not clear myoglobin.
  3. Trisodium citrate is commonly used to anti-coagulate blood running through the dialysis filter.  It is also a potent calcium binding agent.  If using trisodium citrate, it’s important that you aggressively supplement the patient’s calcium (post-filter) to prevent significant hypocalcemia.

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