Table 6.

Areas of ongoing controversy and need for more prospective research in continuous KRT

CKRT-Related Topics Requiring Additional Future Research
Evaluation of optimal approaches to volume management and net ultrafiltration in CKRT
Evaluation of strategies for optimal discontinuation of CKRT and optimal transitioning from CKRT to intermittent HD or PIKRT
CKRT dosing
Validation of approaches to patients with obesity
Determination of safe lower dose limit to better guide dosing in pandemic or resource-limited settings
Determination of dosing of other solute targets besides urea
Evaluation of whether phosphate-containing CKRT solutions improve clinical outcomes beyond correction of hypophosphatemia, such as decreased duration of mechanical ventilation
Evaluation of use of tunneled catheters (rather than nontunneled catheters) for AKI requiring CKRT
Conduction of interventional studies to best validate the following approaches
Precision fluid and solute management
Optimal integration of CKRT into ECMO and other extracorporeal organ support systems (e.g., ECCO2R, blood purification devices)
Nutritional support in CKRT, including how to best mitigate the effects of nonselective removal of amino acids, phosphate, and other micronutrients
Optimal drug dosing in CKRT, especially of antibiotics in the setting of sepsis
Physical therapy/early mobilization in CKRT
Development and validation of risk classification and/or clinical decision support systems to optimize patient selection for CKRT, CKRT delivery, and timing of CKRT initiation and discontinuation
Validation of CKRT quality indicators and benchmarks that could affect clinical and patient-centered outcomes
Evidence-based standardization of CKRT practice and education
Evaluation of equity in CKRT access and delivery to minority populations and in resource-limited settings

CKRT, continuous KRT; HD, hemodialysis; PIKRT, prolonged intermittent KRT; ECMO, extracorporeal membrane oxygenation; ECCO₂R, extracorporeal carbon dioxide removal.