The document discusses continuous renal replacement therapy (CRRT), including its indications, prescription, adverse effects, and comparison to intermittent hemodialysis. CRRT is indicated for hemodynamically unstable patients with acute kidney injury and is used to slowly clear waste and correct fluid/electrolyte imbalances. The prescription details parameters like blood and dialysate flow rates, fluid removal/addition amounts, and anticoagulation. Adverse effects include electrolyte disturbances and bleeding risks. CRRT is more portable and suitable for urgent cases than intermittent hemodialysis.

1. Welcome to Egypt
Mansoura

2. Continuous Renal Replacement
Therapy
By
Salwa Mahmoud Elwasif, MD
Renal Transplantation and Hemodialysis Unit

3. Why?

4. Indications of CRRT:
• Indications of hemodialysis
• Indications of choosing CRRT
K ?
acidosis

6. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate flow
• Fluid removal
• Fluid addition
• Anticoagulation
slow

7. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation
25ml/kg/hr.

8. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation
SCUF, CVVHD, CVVHDF

9. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation
Predialysis post dialysis
dilutes the blood in the
filter,
concentrates the blood
in the filter
reducing clotting. enhancing clearance

12. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation

14. Adverse effect
• Electrolytes disturbance Risk
(required frequent monitoring)
• Bleeding versus filter clotted
• Frequent drug dose modification.

15. Comparison
CRRT
• portable
Intermittent HD
• Water supply and drain are
available
• Water treatment is not big
issue.

16. Comparison
CRRT
• It is easy to do even by
nurse
Interrupted HD
• There are many many expert
nurses

17. Comparison
CRRT
• Used in hemodynamic
unstable patients
Intermittent HD
• Used as SLED

21. Comparison
CRRT Intermittent HD
• Expensive
• Not always available
• Not suitable for urgent
indications

22. Comparison
CRRT Intermittent HD
• IHD looks like a rabbit
• The rabbit is rapid

23. 100 years of service

24. We need both of them

25. Case scenario
• A 72 years gentleman
• Solitary left kidney (right was nephrectomized
since 1990)
• Bronchopneumonia, hypoxemia
• Disturbed conscious level
• AKI on top of CKD (serum Cr. =9.5mg/dl )
• Blood pressure maintained on noradrenaline
iv infusion.

26. Options for RRT

27. ARRYTHEMIA

29. Prescription
• Blood flow (titrated up to 200ml/min)
• Dose (25x80=2000ml/hr.)
• Mode CVVHDF
• Substitution fluid (Predialysis or post dialysis)
• Dialysate flow
• Fluid removal ( fluid intake-insensible loss)
• Fluid addition
• Anticoagulation (heparin infusion 400IU/hr)