Table 3. Algorithm for RRT prescription.
| Clinical variables | Operational variables | Setting |
|---|---|---|
| Fluid balance | Net Ultrafiltration | A continuous management of negative balance (100–300 ml/h) is preferred in
hemodynamically unstable patients. |
| Adequacy and Dose | Clearance/Modality | 25–35 ml/Kg/h for CRRT, consider first CVVHDF (even if no evidence is available about
which modality is better). If IHD is selected, at least a Kt/V of 1.3 on alternate days should be targeted even if fluid balance can be adequately managed only by everyday dialysis. |
| Acid–Base | Solution Buffer | Bicarbonate buffered solutions are preferable to lactate buffered solutions in case of lactic
acidosis and/or hepatic failure. |
| Electrolyte | Dialysate/Replacement | Consider solutions without K + in case of severe hyperkalemia. Manage accurately MgPO 4. |
| Timing | Schedule | Early and “adequate” RRT is suggested even if no specific recommendation is available. |
| Protocol | Staff/Machine | Well-trained staff should routinely utilize RRT monitors according to predefined institutional
protocols. |
Abbreviations: CVC, central venous catheter; S-G, Swan Ganz catheter; EKG, electrocardiogram; CRRT, continuous renal replacement therapy; CVVHDF, continuous veno-venous hemodiafiltration; IHD, intermittent hemodialysis; MgPO 4, magnesium phosphate.