Prescription of CRRT: a pathway to optimize therapy
Continuous renal replacement therapy (CRRT) is a predominant form of renal replacement therapy (RRT) in the intensive care unit (ICU) due to its accurate volume control, steady acid–base and electrolyte correction, and achievement of hemodynamic stability.

This manuscript reviews the different aspects of CRRT prescription in critically ill patients with severe AKI, sepsis, and multiorgan failure in ICU.

These include the choice of CRRT versus Intermittent and extended hemodialysis (HD), life of the filter/dialyzer including assessment of filtration fraction, anticoagulation including regional citrate anticoagulation (RCA), prescribed versus delivered CRRT dose, vascular access management, timing of initiation and termination of CRRT, and prescription in AKI/sepsis including adsorptive methods of removing endotoxins and cytokines.

1. In comparison to conventional intermittent HD, CRRT provides slow and relatively gentle treatment, and is indicated in hemodynamically unstable and brain edema patients.
2. The prescribed dose should be 20–25 ml/kg/h, but to deliver this dose, higher doses are required.
3. To avoid degradation of filter performance due to hemoconcentration, filtration fraction should not exceed 20-25%.
4. The recommended method of anticoagulation is RCA.
5. The preferred location for catheters placement is the right internal jugular vein, followed by the femoral vein and left internal jugular vein.
6. CRRT management also includes consideration of proper timing of initiation and termination- prospective trials have provided conflicting results.
7. While early initiation may have better survival and renal recovery rates, it may be associated with more complications.
8. Finally, although clinical data are relatively scant and also conflicting, removal of endotoxins and cytokines in different settings of sepsis (with or without AKI) may have a positive impact on clinical outcomes.