Continuous Renal Replacement Therapy
| Site: | EHC | Egyptian Health Council |
| Course: | Nursing Procedures Guidelines for Hemodialysis |
| Book: | Continuous Renal Replacement Therapy |
| Printed by: | Guest user |
| Date: | Tuesday, 5 May 2026, 11:38 PM |
Description
"last update: 10 March 2025"
- Prepared by
Under supervision
- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council
Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate
Prepared by
|
Title |
Name |
NO. |
|
Dean Of Faculty Nursing, Professor of Medical and Surgical Nursing, Tanta University |
Dr Afaf Abdel Aziz Abdel Aziz Basal |
1 |
|
Professor Of Critical Care Nursing |
Prof.Dr/Zeinab Hussain Ali |
2 |
|
Professor And Head of the Department of Medical Surgical Nursing. Faculty-. Benha University |
Amal Said Taha Refaie |
3 |
|
Supervisor Of the Education Sector at Port Said University |
Amal Ahmed Khalil Morsy |
4 |
|
Professor Of Medical Surgical Nursing- Faculty of Nursing- Cairo University |
Dr. Hanan Ahmed Al Sebaee |
5 |
|
Head of central administration on secondment at MOHP |
Dr Neveen ab drab al0nabi Mohamed |
6 |
|
Director Of Primary Health Care Nursing Department at MOHP. |
Maysa Hosny Ahmed Tammam |
7 |
|
Supervisor Of Technical Education- EHA |
Nancy Alaa Eldeen Abd-Elbaset Ali |
8 |
|
Supervisor Of Nursing Services Development- EHA |
Sherien Mohamed Saad |
9 |
|
Assistant Professor of Maternity and Neonatal Health Nursing - Faculty of Nursing- Ain Shams University |
Assist.Perof. Dr./Heba Mahmoud Mohammed |
10 |
|
General manager of general administration of health institutes affairs |
Dr Mai Galal Ibrahim Al-Assal |
11 |
|
Participants |
||
|
member of the Nursing administration at EHA, port said branch |
Mr. Ahmed Zarq Al-Sayed |
12 |
|
member of the Nursing administration at EHA, ismailia branch |
Mrs. Radwa Al-Sayd Al-Nagdi
|
13 |
|
member of the Nursing administration at EHA, ismailia branch |
Mrs. Omnia Hassan Absi |
14 |
- What is CRRT “hemodialysis”?
Continuous renal replacement therapy (CRRT) is a type of dialysis used to treat acute kidney injury or chronic kidney disease. It is a slow, continuous process that removes excess fluid, toxins, and waste from the blood, and restores electrolyte and acid-base balance . Unlike traditional intermittent hemodialysis, which is typically performed for 3-4 hours per session, CRRT is performed continuously, 24 hours a day, often using a specialized machine called a hemodialyzer or dialyzer. The hemodialyzer or dialyzer removes excess fluid and waste from the blood and returns the clean blood to the patient's body .
CRRT is recommended for patients with impaired kidney function, also known as acute kidney injury (AKI). ICU patients undergo this treatment 24 hours a day .
- Benefits of Continuous Renal Replacement Therapy (CRRT)
Continuous renal replacement therapy (CRRT) recommended for patients with kidney failure has both short-term and long-term benefits. Short-term benefits of CRRT
Provides continuous removal of excess metabolic waste products from the blood : The CRRT machine allows for the continuous removal of waste products from the blood, such as urea and creatinine, which build up in patients with kidney failure. This can help prevent the buildup of toxic substances in the body that can lead to complications and organ damage .
Restore normal electrolyte and acid/base balance : CRRT can help maintain normal levels of electrolytes, such as sodium, potassium, and calcium, as well as normal acid / base balance. This can prevent serious imbalances that can occur in patients with kidney failure .
Maintains a clear neutral fluid balance : CRRT can help maintain a clear neutral fluid balance, which can prevent fluid overload or dehydration. This is especially important in critically ill patients who may have fluid imbalances due to other medical conditions .
Provides nutritional support regardless of fluid restrictions : CRRT can provide nutritional support to patients who may have fluid restrictions, allowing important nutrients to be delivered without the risk of fluid overload .
Allows for optimal medication administration : CRRT can help improve medication management in patients with kidney failure. Many medications are excreted through the kidneys and can accumulate in patients with kidney failure. CRRT can help remove these medications from the bloodstream, reducing the risk of toxicity.
- Long-term benefits of CRRT
Improve patient survival rate: CRRT has been shown to improve survival rates for critically ill patients with acute kidney injury. By removing toxins and maintaining fluid and electrolyte balance, CRRT can help stabilize patients and prevent complications that can lead to death.
Increases the chance of complete kidney recovery: In some cases, CRRT can help improve kidney function and even lead to complete kidney recovery. This is especially true for cases of acute kidney injury, where early intervention with CRRT can prevent irreversible kidney damage.
CRRT is an advance over conventional dialysis. CRRT is preferred because of its short- and long-term benefits. By removing toxins, maintaining fluid and electrolyte balance, and providing nutritional support, CRRT can help stabilize critically ill patients and improve their chances of survival and renal recovery .
- Types of CRRT
➡️Types of CRRT :
There are several types depending on
the method of blood purification and its purpose, such as :
CVVH (Continuous veno venous Hemofiltration): To slowly remove fluid and waste.
CVVHD (Continuous Veno venous Hemodialysis): Similar to traditional hemodialysis but at a slower rate .
CVVHDF (Continuous Venovenous Hemodiafiltration):
A combination of the two methods to filter toxins and fluids in a balanced manner.
➡️Advantages of continuous hemodialysis machine :
Less stress on the heart and blood vessels : because it removes fluids and toxins slowly, allowing the body to adapt without negative effects on blood circulation .
Suitable for unstable patients : especially in emergency and intensive care situations .
Reducing complications that may occur from rapid dialysis, such as sudden low blood pressure .
- CRRT Treatment Procedures
(CRRT) involves several steps that are very similar to starting hemodialysis:Patient preparation : Before starting CRRT , the patient's vital signs, fluid status, and electrolyte levels are assessed. A dialysis catheter is inserted into a vein, usually in the neck or groin, and the catheter is connected to the CRRT machine.
- Blood flow rate : The blood flow rate is adjusted to ensure adequate removal of toxins and waste. Blood is pumped from the patient's body through the catheter to a hemodialysis machine or blood filter, where it is filtered and purified .
- Fluid replacement : Replacement fluids are added to the purified blood to maintain the normal electrolyte and fluid balance. The rate of fluid replacement is adjusted based on the patient's fluid status and electrolyte levels.
- Prevent blood clotting : Anticoagulants, such as heparin or citrate, are used to prevent blood from clotting in a blood filter or dialyzer . The dose of anticoagulants is carefully monitored to avoid bleeding or clotting complications .
- Monitoring and Adjustments : The patient's vital signs, fluid status, electrolyte levels, and blood flow rate are continuously monitored. The CRRT device is adjusted as needed to maintain optimal treatment parameters and avoid complications .
- Stop : CRRT may be stopped once the patient's kidney function improves or if the patient is transferred to another form of renal replacement therapy, such as intermittent hemodialysis or peritoneal dialysis .
CRRT is a complex and highly specialized procedure that requires careful monitoring and adjustments to ensure optimal outcomes for the patient. The treatment is performed by a team of healthcare professionals, including nephrologists and nurses, who work together to provide the best possible care for the patient .CRRT does some of the work that healthy kidneys do naturally. It gently filters and cleanses the patient’s blood by removing waste products and extra fluid. This maintains the balance of chemicals and electrolytes, such as potassium and phosphorus, in your child’s blood. CRRT doesn’t actually improve the patient’s kidney function, but instead keeps everything in his or her body in line until the kidneys regain function.
The central venous catheter is connected to a machine that circulates some of the patient's blood in a loop outside the body. After the blood is filtered and cleaned, it is returned to the body.
There are situations in which a patient is disconnected from the CRRT device These include
- If it needs to perform a test or procedure. The device will then restart.
- Routine replacement of pipes and filters to keep the system working well. This only requires a short period of shutdown.
- Sometimes, small blood clots get into the filter and tubing and prevent the machine from working properly. A nurse will change the tubing and filter if this happens.
The device alarm may sound during CRRT . Most alarms are not due to an emergency. They are usually intended to alert the nurse to change the solution bags. The device alarm may also sound to tell the nurse to change the patient's position or check the catheter to help the treatment go smoothly.
- Continuous washing machine risks
· severe bleeding
· infection
· blood clot in blood vessels
· Electrolyte problems
· low body temperature
· low blood pressure
· blood loss
- flaws Continuous hemodialysis machine
· It requires continuous monitoring : Since it operates 24 hours a day, there must be a medical team that monitors the patient’s condition and the device regularly .
· More complex than regular dialysis, and requires a skilled medical team .
· Higher cost : due to specialized hardware and additional resources required .
- References - المراجع
◼️ Tolwani A. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med. 2022;367(26):2505–2514. doi: 10.1056/NEJMct1206045.
◼️ Vinsonneau C., Camus C., Combes A. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2019;368(9533):379–385.
◼️ Schwenger V., Weigand M.A., Hoffmann O. Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury—a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts. Crit Care. 2022;16(4):R140. doi: 10.1186/cc11445.