Dialysis & CRRT

Kidneys, Electrolytes & Acid–Base · ICU Decoded chapter 51 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to KDIGO AKI 2012 · CRRT dosing guidance.

Key points

Choose continuous (CRRT) for hemodynamically unstable patients or cerebral edema, intermittent HD for stable patients, SLED as a hybrid.
CRRT dose 20–25 mL/kg/h effluent; anticoagulate with regional citrate (watch calcium) or heparin.
Access: non-tunneled femoral/IJ (avoid subclavian — stenosis); remove promptly when done.
On CRRT, adjust renally cleared drugs (antibiotics!).
Start kidney replacement therapy for a defined indication — refractory hyperkalaemia, refractory acidosis, refractory overload, uraemic encephalopathy or pericarditis, or a dialysable poison — and not for a creatinine value: accelerated initiation gave no survival benefit in STARRT-AKI and left more survivors dialysis-dependent.

Investigations

First tests: Sodium, potassium, bicarbonate, urea and creatinine, Arterial blood gas, Ionized calcium, Phosphate.

Only if indicated: Total and ionized calcium; citrate-protocol tests, Anticoagulation-specific monitoring.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine, Phosphate, Urine output and fluid balance.

Management pathways in this chapter

When to Start Kidney Replacement Therapy in AKI
Prescribing and Running CRRT
Adjusting Drug Doses in AKI and on CRRT

Locked

Each pathway step by step, with its decision points
Treatment orders with doses
Why and when to send each test

Open the full chapter in ICU Decoded

Free with a referral from any ICU Decoded member, or by applying with your medical registration. How access works.

← AKI: Workup & Management · Sodium, Potassium, Calcium & Magnesium →

More in Kidneys, Electrolytes & Acid–Base

Part of ICU Decoded — open the interactive version.

ICU Decoded — original critical-care and internal-medicine pathways by Dr Javed Akhtar, each cited to a current guideline. For education and quick reference; verify every dose against local protocols before prescribing.

Open the app · Ward Pathways — 87 cases · ICU Decoded chapters · Aladin Chirag bedside tools

How to use · About · Medical disclaimer · Privacy · Contact