CRRT Update

A nice review in NEJM current issue Dec 2012, there is a clinical perspective review on CRRT use in AKI.
Dr. Tolwani reviews the implications of CRRT and the current state of practice. From the indications to the different clinical trials, the review nicely summarizes last few years of research and practice.
Two great tables to take home: Table 1 discusses the different modalitis( CVVH, CVVHD and CVVHDF) and compares it via solute transport, replacement fluid and flow rates. It is a nice summary table for many trainees to review.  Important to emphasize the true indications for use of CRRT and then which one of the above to choose. The access is an important component discussed as choice of vein should be in order of IJ>femoral>subclavian. In addition, anticoagulation is important as many times, heparin cannot be used in such cases and citrate based CRRT might be needed. Data on that are slowly emerging. Finally, dosing of drugs and antibiotics is important consideration in CRRT.