Continuous Renal Replacement Therapy (CRRT)
Continuous renal replacement therapy (CRRT) is a blood purification method applied to patients with acute kidney injury (AKI). In CRRT, the patient’s blood is circulated through a specialised filter that eliminates fluid and uremic toxins before returning purified blood to the body. This gradual and continuous process, usually conducted over 24 hours, enables patients with unstable blood pressure and heart rates (referred to as hemodynamically unstable) to endure the treatment more effectively. CRRT is commonly used to support kidney function in critically ill patients with acute kidney injury, especially those who are unstable.
At Apollo Hospital in Jubilee Hills, Hyderabad, our department of nephrology is equipped with continuous renal replacement therapy (CRRT) delivering advanced kidney care to the patients with acute kidney injury (AKI) or acute renal failure (ARF).
Why To Choose Continuous Renal Replacement Therapy (CRRT)
Continuous renal replacement therapy (CRRT) is a preferred treatment for acute kidney failure because it offers several advantages:
- Manages blood pressure
- Balances minerals and acid/base chemicals
- Maintains proper fluid levels in the body
- Keeps electrolyte levels normal
- Continuously removes extra fluid and waste products from the blood
- Increases chances of survival
- Enhances the likelihood of full recovery
What Happens In Continuous Renal Replacement Therapy (CRRT)?
- Patient Evaluation: Before initiating CRRT, a thorough evaluation of the patient’s medical history, current condition, and kidney function is conducted. This helps determine the appropriate CRRT prescription and settings.
- Vascular Access: A vascular access is established to allow continuous removal and return of blood during CRRT. This is typically achieved through the insertion of a hemodialysis catheter into a large vein, such as the jugular, subclavian, or femoral vein.
- Connection to CRRT Machine: The hemodialysis catheter is connected to the CRRT machine, which contains the necessary components for blood purification.
- Blood Pumping and Filtration: The CRRT machine pumps blood from the patient through a filter, known as the hemofilter or dialyzer. This filter removes waste products, excess fluids, and electrolytes from the blood.
- Dialysate and Replacement Fluids: In addition to filtration, CRRT may involve the use of dialysate and replacement fluids to help maintain electrolyte balance and remove toxins. Dialysate is a solution used to help facilitate solute removal, while replacement fluids help replace lost fluids and maintain adequate blood volume.
- Anticoagulation: To prevent blood clotting within the CRRT circuit, anticoagulation may be administered. Various anticoagulation strategies, such as systemic heparinization or regional citrate anticoagulation, may be employed based on patient factors and machine settings.
- Continuous Monitoring and Adjustments: Throughout the CRRT procedure, patients are closely monitored for vital signs, electrolyte levels, fluid balance, and other parameters. The CRRT prescription may be adjusted based on the patient’s response and clinical status.
- Duration of Therapy: CRRT is typically administered continuously over a prolonged period, often 24 hours a day or more. The duration of therapy depends on the patient’s condition, renal function, and response to treatment.
- Nursing Care: Skilled nursing care is essential during CRRT to ensure patient safety, monitor for complications, and provide ongoing support. Nurses frequently assess vascular access, monitor vital signs, troubleshoot machine alarms, and address patient comfort and well-being. CRRT is overseen by a multidisciplinary healthcare team, including nephrologists, intensivists, nurses, and other specialists. Physicians are responsible for prescribing and adjusting CRRT therapy based on clinical assessments and laboratory results.
Potential Risks Associated With Continuous Renal Replacement Therapy (CRRT)
While continuous renal replacement therapy (CRRT) is beneficial, it shares some potential complications with hemodialysis. These include:
- CRRT may cause blood pressure to drop, leading to dizziness or fainting. Certain patients may experience irregular heartbeats during CRRT.
- Some individuals may develop allergic responses to the materials used in CRRT.
- CRRT can increase the risk of bleeding due to anticoagulation therapy or the insertion of catheters. Blood clots may form within the CRRT circuit, potentially obstructing blood flow.
- Patients may become too cold during CRRT, necessitating measures to maintain body temperature.
- Incorrect fluid removal or replacement may occur, leading to dehydration or fluid overload.
- There is a risk of infections associated with catheter insertion or exposure to contaminated equipment.
- CRRT can remove essential nutrients from the blood, necessitating careful monitoring and supplementation.
Morning 
afternoon 
evening 