Table 3.
Potential indications for continuous KRT in patients who are critically ill with AKI
| Potential Indication | |
|---|---|
| Classic indications for KRT in the setting of hemodynamic instability | |
| Hyperkalemia | |
| Severe metabolic acidosis | |
| Diuretic-resistant volume overload | |
| Life-threatening or severe complications of uremia (e.g., bleeding in the setting of uremic platelet dysfunction, pericarditis) | |
| Poisoning with dialyzable toxins (e.g., toxic alcohols, salicylates, lithium)a | |
| Persistent oliguria or anuria | |
| CKRT-specific indications | |
| Gradual correction of severe dysnatremia (e.g., serum [Na+] <120 mEq/L or >165 mEq/L) | |
| Intracranial hypertension or conditions associated with high risk of intracranial hypertension or requiring maintenance of therapeutic hypernatremia (e.g., acute liver failure, acute brain injury) | |
| Cardiopulmonary failure requiring ECMO or other mechanical circulatory support | |
| Organ support in patients with advanced heart or liver disease unable to tolerate intermittent HD, especially when used as a bridge to transplantation or other destination therapy | |
| Conditions requiring continuous solute removal due to high cell turnover or cell lysis (e.g., rhabdomyolysis or tumor lysis syndrome) |
CKRT, continuous KRT; [Na+], sodium concentration; ECMO, extracorporeal membrane oxygenation; HD, hemodialysis.
a
Intermittent HD, given its higher clearance, is generally preferred over CKRT in the treatment of poisonings, but CKRT can be considered in patients with severe hemodynamic instability.