A Clinical Review of Continuous Renal Replacement Therapy: Modalities, Indications, and Management in Critical Care

Elmukhtar Habas¹, Ala Habas², Amnna Rayani³, Khaled Alarabi⁴

Keywords: Continuous renal replacement therapy (CRRT), acute kidney injury (AKI), critical care, hemodiafiltration, regional citrate anticoagulation, drug dosing, metabolic complications

DOI: 10.63475/yjm.v4i3.0259

DOI URL: https://doi.org/10.63475/yjm.v4i3.0259

Publish Date: 31-12-2025

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Pages: 492 - 506

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Downloads: 4

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Author Affiliation:

1 Professor, Senior Consultant, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
2 Medicine Resident, TCH, University of Tripoli, Tripoli, Libya
3 Professor, Senior Consultant, University of Tripoli, Tripoli, Libya
4 Associate Consultant, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar

Abstract

Continuous renal replacement therapy (CRRT) is a cornerstone of contemporary intensive care for patients experiencing severe acute kidney injury (AKI), especially in cases involving hemodynamic instability or multiorgan dysfunction. In contrast to intermittent modalities, CRRT facilitates gradual and continuous removal of solutes and fluids, thereby enhancing hemodynamic stability and enabling precise metabolic regulation. This review synthesizes existing evidence and practice, outlining the pathophysiology of AKI in critical illness and the technical specifications of core CRRT modalities: Continuous Venovenous Hemofiltration (CVVH), Continuous Venovenous Hemodialysis (CVVHD), and Continuous Venovenous Hemodiafiltration (CVVHDF). It analyzes the evidence-based indications and optimal timing for initiation, highlighting the shift from early empirical use to a strategy guided by specific clinical criteria. The review delineates fundamental operational principles, encompassing dosing (20–25 mL/kg/h effluent), fluid management, and the pivotal function of regional citrate anticoagulation. The prevention and management of complications, particularly electrolyte disturbances such as hypophosphatemia, nutrient depletion, and altered drug pharmacokinetics, is a primary focus. The analysis focuses on key controversies surrounding the application of CRRT for blood purification in sepsis. This discussion situates CRRT within the wider framework of organ support, emphasizing future advancements in personalized medicine, integrated sorbent technologies, and wearable devices. This review outlines a framework for clinicians to enhance CRRT delivery and improve outcomes for critically ill patients, while recognizing the limitations in the evidence base and global accessibility.

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