Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA.
Department of Internal Medicine, Division of Nephrology, University of Alabama, Birmingham, AL, USA.
Semin Dial. 2021 Nov;34(6):432-439. doi: 10.1111/sdi.12974. Epub 2021 Apr 28.
Continuous renal replacement therapy (CRRT) is the preferred modality of extracorporeal renal support for critically ill patients with acute kidney injury (AKI). The dose of CRRT is reported as effluent flow in ml/kg body weight per hour (ml/kg/h). Solid evidence supports that the delivered CRRT effluent dose for critically ill patients with AKI should be 20-25 ml/kg/h on average. To account for treatment interruptions and the natural decline in filter efficiency over time, it is recommended to prescribe 25-30 ml/kg/h of effluent dose. However, transient higher doses of CRRT in specific clinical scenarios may be needed to accommodate specific solute control needs of a particular patient at a given time. Consequently, there should be consideration of the potential adverse consequences of non-selective clearance such as undesired antimicrobials and nutrients removal. In this manuscript, we provide a summary of evidence related to CRRT dose, practical aspects for its calculation at the time of prescribing CRRT, and considerations for addressing the expected gap between prescribed and delivered CRRT dose. We also provide a framework for monitoring and implementation of CRRT dose as a quality indicator of CRRT delivery.
连续肾脏替代治疗（CRRT）是治疗急性肾损伤（AKI）危重症患者的体外肾脏支持的首选方法。CRRT 的剂量以每小时每公斤体重的流出量（ml/kg/h）表示。有确凿的证据支持，对于 AKI 的危重症患者，应平均给予 20-25ml/kg/h 的 CRRT 流出剂量。为了考虑到治疗中断和随着时间的推移过滤器效率的自然下降，建议开出 25-30ml/kg/h 的流出剂量。然而，在特定的临床情况下，可能需要短暂给予更高剂量的 CRRT，以适应特定患者在特定时间的特定溶质控制需求。因此，应该考虑非选择性清除的潜在不良后果，如不必要的抗菌药物和营养物质的清除。在本手稿中，我们总结了与 CRRT 剂量相关的证据，在开具 CRRT 时计算其剂量的实际方面，以及解决预期的处方和给予的 CRRT 剂量之间差距的考虑因素。我们还提供了一个监测和实施 CRRT 剂量的框架，作为 CRRT 输送的质量指标。
