# CRRT: Prescribe, Deliver, Reassess

Reassess kidney recovery, changing stability, and readiness for another modality or discontinuation. Continuous therapy should have an active daily purpose.

![Infographic: CRRT: Prescribe, Deliver, Reassess](https://urinenephrology.org/visual-reference/images/mastery-crrt.png?v=20261003c)

## Continuous support

Continuous kidney replacement offers gradual solute and fluid management, often useful in unstable patients. Clearance depends on the selected modality and delivered effluent.

## Clarify the indication

Assess electrolyte emergencies, acidemia, fluid overload, uremia, and ongoing metabolic demand. Hemodynamic instability informs modality but does not define the entire prescription.

## Prescribe for the delivered dose

KDIGO recommends a delivered effluent dose of 20–25 mL/kg/hour in AKI. A higher prescription may be needed to account for downtime and predilution. Measure actual delivery and circuit interruption; routine escalation above standard intensity has not shown better survival or renal recovery.

## Titrate net fluid removal

Separate clearance goals from the patient's net fluid balance. Adapt removal to perfusion, vasopressors, capillary refill, congestion, and the evolving illness.

## Recognize circuit and metabolic complications

Recurrent filter clotting reduces delivered therapy and causes blood loss. With citrate anticoagulation, follow systemic and postfilter ionized calcium, acid–base status, and the total-to-ionized calcium pattern under the unit protocol. Rising calcium requirements or unexplained acidosis warrants prompt review for citrate accumulation.

## Plan transitions

Reassess kidney recovery, changing stability, and readiness for another modality or discontinuation. Continuous therapy should have an active daily purpose.

## Supporting evidence

- [Supporting guideline or source](https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf)

## Source lessons

- [crrt principles](https://urinenephrology.org/mastery/dialysis-advanced/crrt-principles.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.