Continuous Renal Replacement Therapy (CRRT) is a therapy perfected over traditional dialysis designed for very ill patients with acute kidney injury (AKI). Unlike the conventional dialysis, CRRT is a procedure that continues for 24 hours, thereby making it gentler and much more effective in the elimination of fluids and wastes for the patient found in the intensive care unit (ICU).
This therapy is very suitable for someone who tolerates not having fluid change quickly: such a person may be one suffering from unstable blood pressure or multi-organ failure. However, CRRT is like every other medical procedure with risks and considerations to be addressed. Want to learn how CRRT operates, its advantages, and probable complications? Continue reading to explore everything you need to know!
Is Continuous Renal Replacement Therapy (CRRT) Safe?
Generally, Continuous Renal Replacement Therapy (CRRT) is safe as long as it has been done under strict supervision of medical practitioners. However, it has some bleeding and further complications that could arise through electric imbalance, thus needing to be monitored well. Some of them emerge as complications due to vascular access done, thus leading to clotting and infection. The use of CRRT should therefore be in an ICU staffed by experienced healthcare providers.
CRRT is therefore an integral therapy for very sick people with acute kidney injury, with its gradual process being particularly valuable in patients who cannot tolerate rapid removal of fluids. Strict medical protocol minimizes risks and maximizes patient outcome in the use of CRRT. When handled the right way, CRRT provides its patients with excellent chances of survival and recovery.
Procedure
CRRT is a complex yet lifesaving process. Here’s how it works in five essential steps.
1. Catheter Insertion
The procedure begins with the insertion of a catheter into a large vein, typically in the neck or groin. This catheter serves as an access point for blood to be drawn out and returned after filtration. Our expert medical team ensures that this step is performed with precision and sterility to minimize the risk of infection and complications.
2. Blood Extraction
Once the catheter is in place, blood is drawn from the patient’s body and directed into the CRRT machine. This step is carefully controlled to maintain stable blood pressure and prevent sudden drops in circulation.
3. Filtration Through a Hemofilter
The extracted blood then passes through a hemofilter, where waste products, toxins, and excess fluids are removed. This filtration mimics the natural function of healthy kidneys, allowing for precise management of fluid balance and waste removal.
4. Replacement Fluid and Electrolyte Balancing
Depending on the patient’s condition, a replacement fluid may be added to maintain proper electrolyte levels and prevent imbalances that could harm vital organs.
5. Blood Return to the Body
After filtration, the purified blood is returned to the patient’s body through the same catheter. This continuous process ensures stable and effective blood purification with minimal impact on the patient’s hemodynamics.
CRRT encompasses several modalities, each tailored to specific patient needs:
- Continuous Venovenous Hemofiltration (CVVH): Utilizes convection to remove larger solutes by filtering plasma water through a semipermeable membrane.
- Continuous Venovenous Hemodialysis (CVVHD): Employs diffusion to clear smaller solutes, with dialysate flowing countercurrent to blood flow.
- Continuous Venovenous Hemodiafiltration (CVVHDF): Combines convection and diffusion to efficiently remove both small and large solutes.
The choice among these modalities depends on the patient’s specific clinical condition and treatment objectives.
Benefits
CRRT offers a wide range of benefits, making it an essential therapy for critically ill patients with acute kidney injury.
1. Maintains Hemodynamic Stability
One of the biggest advantages of CRRT is its ability to maintain hemodynamic stability. Unlike intermittent hemodialysis, which can cause sudden drops in blood pressure, CRRT provides a slower, more controlled filtration process, reducing the risk of hypotension.
2. Better Fluid Management
CRRT allows for precise control of fluid balance, which is crucial for patients with significant fluid overload or those requiring large volumes of intravenous medications. This targeted approach prevents complications such as pulmonary edema and cardiovascular strain.
3. Effective Removal of Toxins and Electrolyte Imbalance Management
The continuous filtration process enables effective removal of toxins and metabolic waste while maintaining balanced electrolytes. This is particularly beneficial for patients suffering from severe acidosis or electrolyte disturbances.
4. Ideal for Patients with Increased Intracranial Pressure
Unlike intermittent hemodialysis, which can lead to rapid changes in brain water content, CRRT ensures stable cerebral perfusion. This makes it an excellent choice for patients with neurological conditions or traumatic brain injuries.
5. Customizable Treatment
Since CRRT offers different modalities (CVVH, CVVHD, and CVVHDF), treatment can be tailored to meet individual patient needs, ensuring the best possible outcomes.
Risks
Despite its many benefits, Continuous Renal Replacement Therapy is not without risks. Here are some potential complications associated with the therapy.
1. Bleeding and Infection
The insertion of a central venous catheter carries risks such as bleeding and infection. At BIMC Hospital Kuta, we take stringent precautions to minimize these risks, using sterile techniques and closely monitoring patients.
2. Blood Clots in the Circuit
The continuous nature of CRRT means that blood is constantly flowing through external tubing, increasing the risk of clot formation. To counteract this, anticoagulation therapy is often used, but this itself carries a risk of bleeding.
3. Electrolyte Imbalances
While CRRT helps maintain electrolyte balance, improper adjustments to the therapy can lead to imbalances, such as hypokalemia (low potassium) or hypernatremia (high sodium). Regular monitoring is essential to prevent complications.
4. Hypothermia
The extracorporeal circulation of blood can cause heat loss, leading to hypothermia in some patients. Our medical team actively monitors and regulates body temperature during the procedure to ensure patient safety.
5. Financial and Logistical Considerations
CRRT is more expensive and resource-intensive compared to intermittent hemodialysis. It requires specialized equipment, continuous monitoring, and a dedicated healthcare team, making it less accessible in some medical settings.
Briefly, Continuous Renal Replacement Therapy is a vital tool in managing acute kidney injury in critically ill patients. Its continuous and gentle approach to blood filtration provides significant advantages, including better hemodynamic stability, precise fluid management, and effective toxin removal. However, like any medical procedure, it comes with risks that must be carefully managed through close monitoring and expert care.
At BIMC Hospital Kuta, we are committed to providing top-tier CRRT services tailored to each patient’s unique needs. Our dedicated team of specialists ensures that every aspect of the therapy is conducted with precision, safety, and the utmost care. If you or a loved one requires CRRT, don’t hesitate to reach out to us. Visit BIMC Hospital Kuta today to learn more about our expert renal replacement therapy services and how we can support you on the path to recovery.
