What Has Changed in Renal Replacement Treatments?

In the intensive care unit (ICU), acute kidney injury (AKI) is a common and serious complication that significantly affects patient prognosis. High incidence in the ICU is correlated with increased mortality rates. Approximately 50% of ICU patients develop AKI, and 13.5% require renal replacement therapy (RRT). Continuous RRT (CRRT) is particularly beneficial for hemodynamically unstable patients, aiding in dialysis and correction of fluid-electrolyte imbalances, and is effective for patients on vasopressors. The primary RRT modalities currently in use are the following 1. Intermittent hemodialysis, 2. Peritoneal dialysis, 3. Slow low-efficiency daily dialysis, 4. CRRTs. Intiating CRRT in patients with AKI helps prevent uremia and sudden death from renal failure complications. Despite the presumed significance of the timing, modality, and dosing of CRRT on clinical outcomes, research in this area is limited, thereby rendering the role of CRRT in AKI management controversial. Initiating CRRT involves selecting an appropriate device and method, choosing a suitable catheter and filter, and determining blood flow and ultrafiltration rates. This review discusses the emergency indications for CRRT, definitions of RRT modalities, CRRT program implementation, CRRT prescription, management including blood flow rate and solutions, complications, anticoagulation strategies, prevention of clotting issues, citrate accumulation, contraindications, RRT in sepsis guidelines, and nutritional aspects. As a result, considering the scarcity of reviews written on this subject, we aimed to present a practical approach by adding the missing topics on this subject and supporting topics, such as dose calculations and anticoagulation management, with current literature in the light of practical applications.