Critical care in patients on continuous renal replacement therapy

anticoagulation and nutritional management

Abstract

Patients receiving continuous renal replacement therapy (CRRT) suffer not only from acute kidney injury (AKI), but also severe sepsis and/or multiple organ failure. Anticoagulation and nutritional management are important to improve the prognosis of these patients. In order to delay the clotting of the filter and CRRT circuit, anticoagulants are frequently used. However, circuit anticoagulation increases risk of bleeding. Therefore, the risks and benefits of intense anticoagulation must be considered. There is no direct evidence for optimal nutritional management in patients undergoing CRRT；therefore, nutritional management based on the management of AKI or sepsis is recommended in patients receiving CRRT. Sufficient administration of drugs, nutrition and blood transfusion is possible, because removal of unwanted solutes can be achieved through CRRT. On the other hand, a part of the administered nutrients such as vitamins and trace elements, as well as drugs are also removed. In CRRT, underfeeding may be permitted after assessment of the energy expenditure and nitrogen balance. Whenever possible, even if in little quantities, the patients should be fed enterally.