CONTINUOUS RENAL REPLACEMENT THERAPY CRRT

Question 1

What are the urgent indications for CRRT?

Answer 1

• Refractory fluid overload
• Hyperkalemia (>6 mEq/L or rapidly rising)
• Signs of uremia
• Severe metabolic acidosis (pH < 7.2)
• Certain drug/alcohol intoxications

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Question 2

What are the non-urgent indications for CRRT?

Answer 2

• Progressive azotemia
• Oliguria despite optimal medical management
• Positive fluid balance despite aggressive diuresis

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Question 3

What were the findings of the AKIKI Study regarding CRRT?

Answer 3

No mortality benefit with early RRT.

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Question 4

What did the ELAIN Study conclude about CRRT?

Answer 4

Early RRT reduced 90-day mortality and improved kidney recovery.

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Question 5

When should RRT be initiated according to recommendations?

Answer 5

Before severe electrolyte disturbances.

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Question 6

What is the primary advantage of Continuous Renal Replacement Therapy (CRRT)?

Answer 6

Hemodynamic stability and better solute clearance.

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Question 7

What are the modalities of RRT?

Answer 7

• Intermittent Hemodialysis (IHD)
• Continuous Renal Replacement Therapy (CRRT)
• Prolonged Intermittent RRT (PIRRT)
• Peritoneal Dialysis (PD)

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Question 8

What are the different types of CRRT?

Answer 8

• CVVH: Continuous venovenous hemofiltration
• CVVHD: Continuous venovenous hemodialysis
• CVVHDF: Continuous venovenous hemodiafiltration

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Question 9

What is the preferred vascular access site for CRRT?

Answer 9

• Right internal jugular
• Femoral
• Left internal jugular
• Subclavian (last resort due to complications)

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Question 10

What is the recommended flow rate for CRRT dose?

Answer 10

Effluent flow rate ≥20 mL/kg/hour (prescribe ≥25 mL/kg/hour).

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Question 11

What is the target Kt/V for IHD?

Answer 11

• Kt/V ≥1.2 per session (3 sessions/week)
• Weekly Kt/V ≥3.9 (based on ATN study)

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Question 12

What are common complications of CRRT?

Answer 12

• Hypotension (most common)
• Bleeding (due to anticoagulation)
• Electrolyte imbalances (hypocalcemia, hypophosphatemia, hypokalemia)
• Infection (catheter-related)
• Hypothermia (prolonged extracorporeal circulation)

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Question 13

What are indications for stopping CRRT?

Answer 13

• Improvement in urine output
• Decline in serum creatinine levels
• Measured creatinine clearance >20 mL/min

ATN Study: Discontinued RRT at creatinine clearance >20 mL/min.

Question 14

True or False: CRRT is preferred for hemodynamically stable patients.

Answer 14

False

CRRT is preferred for hemodynamically unstable patients.

Question 15

What anticoagulation method is preferred in CRRT?

Answer 15

Regional citrate anticoagulation over heparin.

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Question 16

Fill in the blank: CRRT should be discontinued when kidney function recovers at a creatinine clearance of _______.

Answer 16

creatinine clearance >20 mL/min

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