Indications for CRRT in the Critically Ill
16/8/10
Fluid Overload
- patients with renal failure and have developed acute pulmonary oedema.
- CRRT may be required to prevent or treat respiratory failure in this scenario.
Acid
- renal failure produces a situation where the patient is unable to excrete organic acids.
- this can lead to a severe metabolic acidosis -> respiratory distress + encephalopathy
Hyperkalaemia
- hyperkalaemia can result in life threatening arrhythmias.
- patients are particularly prone to this over a K+ of 6.5mmol/L
- I would institute CRRT in patients while undertaking medical treatment to lower K+ until
dialysis could be started.
Extras/Others
- toxins – dialyzable drugs in intoxication +/- haemofiltration with charcoal (lithium,
theophylline, myoglobin)
- sepsis – removal of cytokines mediating SIRS
- uncontrolled electrolyte disturbances – hyponatraemia
- uraemia (urea >30mmol/L)
- as complications have minimized CRRT has been initiated earlier (oliguria, lower creatinine)
- newer extracoroporeal techniques include ‘liver dialysis’ – filter coated with albumin to
attract toxins that are normally cleared by the liver.
Jeremy Fernando (2011)