🩺 Renal Replacement Therapy Initiation Indication (CRRT/RRT)
UseUse to identify emergent RRT indications and to choose between continuous (CRRT) and intermittent (IHD) modal…
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SourceKDIGO Clinical Practice Guideline for AKI. Kidney Int Suppl 2012.
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋Renal function / dosingOpen scene pack →Related scores
Matching pathway
🧭hyperkOpen pathway →Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
Do not apply chronic-CKD BUN/creatinine thresholds to the critically ill; emergent indications and overall trajectory drive timing (original synthesis · not guideline verbatim).
When to use
Use to identify emergent RRT indications and to choose between continuous (CRRT) and intermittent (IHD) modalities based on hemodynamics.
How it works
Any emergent indication (refractory hyperkalemia, severe acidosislife-threatening acid–base imbalance, refractory volume overload, uremic complications/severe azotemia, dialyzable poisoning) initiates RRT; without these, decide early vs late by trends. CRRT preferred when hemodynamically unstable/brain-injured.
Key points
- Do not apply chronic-CKD BUN/creatinine thresholds to the critically ill; emergent indications and overall trajectory drive timing (original synthesis · not guideline verbatim).
- Trials of early vs delayed initiation (AKIKI, IDEAL-ICU, STARRT-AKI) have not shown consistent benefit to routine early start.
- CRRT offers smoother hemodynamics and ICP control; IHD corrects hyperkalemia faster in stable patients.
References
- [Guideline / primary source]KDIGO Clinical Practice Guideline for AKI. Kidney Int Suppl 2012.
- STARRT-AKI Investigators. N Engl J Med 2020.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Refractory hyperkalemia life-threatening electrolyte imbalanceor rapidly rising, hard to control medically) | No |
|---|---|
| Refractory severe metabolic acidosis life-threatening acid–base imbalance | No |
| Refractory volume overload/pulmonary edema (diuretic-resistant) | No |
| Uremic symptoms (encephalopathy/pericarditis/bleeding) or severe azotemia | No |
| Dialyzable toxin/drug poisoning (e.g. lithium, methanol, ethylene glycol, salicylate) | No |
| Hemodynamically unstable (needs vasopressors/brain injury/raised ICP) | No |
→RRT initiationNo emergent indication
- Determination：No emergent indication above: in the critically ill, do not wait for traditional CKD thresholds; decide early vs late initiation by volume/metabolic trends and overall clinical picture (evidence for early benefit is inconsistent)
- Modality choice：IHD or CRRT (IHD acceptable if hemodynamically stable; IHD is faster for rapid hyperkalemia correction)
- Management direction：Continue medical management (hyperkalemia, acidosis, volume), monitor urine output/electrolytes/acid-base and azotemia trends
| Refractory hyperkalemia life-threatening electrolyte imbalanceor rapidly rising, hard to control medically) | Yes |
|---|---|
| Refractory severe metabolic acidosis life-threatening acid–base imbalance | Yes |
| Refractory volume overload/pulmonary edema (diuretic-resistant) | Yes |
| Uremic symptoms (encephalopathy/pericarditis/bleeding) or severe azotemia | Yes |
| Dialyzable toxin/drug poisoning (e.g. lithium, methanol, ethylene glycol, salicylate) | Yes |
| Hemodynamically unstable (needs vasopressors/brain injury/raised ICP) | Yes |
→RRT initiationEmergent indication present
- Determination：Emergent indication present: refractory hyperkalemia, severe acidosis life-threatening acid–base imbalance, volume overload/pulmonary edema, uremia/severe azotemia, dialyzable poisoning → start renal replacement therapy
- Modality choice：CRRT (continuous; preferred over intermittent hemodialysis when hemodynamically unstable/brain injury/raised ICP, reducing blood-pressure and ICP swings)
- Management direction：Start RRT promptly and correct triggers concurrently; hemodynamic instability favors CRRT, effluent dose 20–25 mL/kg/h; anticoagulation preferably regional citrate (if no contraindication)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Renal Replacement Therapy Initiation Indication (CRRT/RRT)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Renal Replacement Therapy Initiation Indication (CRRT/RRT) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Renal Replacement Therapy Initiation Indication (CRRT/RRT) calculated in practice? Can you show a worked example?
- Inputs: Refractory hyperkalemia life-threatening electrolyte imbalanceor rapidly rising, hard to control medically) No, Refractory severe metabolic acidosis life-threatening acid–base imbalance No, Refractory volume overload/pulmonary edema (diuretic-resistant) No, Uremic symptoms (encephalopathy/pericarditis/bleeding) or severe azotemia No, Dialyzable toxin/drug poisoning (e.g. lithium, methanol, ethylene glycol, salicylate) No, Hemodynamically unstable (needs vasopressors/brain injury/raised ICP) No → Result: RRT initiation No emergent indication（Determination: No emergent indication above: in the critically ill, do not wait for traditional CKD thresholds; decide early vs late initiation by volume/metabolic trends and overall clinical picture (evidence for early benefit is inconsistent), Modality choice: IHD or CRRT (IHD acceptable if hemodynamically stable; IHD is faster for rapid hyperkalemia correction), Management direction: Continue medical management (hyperkalemia, acidosis, volume), monitor urine output/electrolytes/acid-base and azotemia trends） Inputs: Refractory hyperkalemia life-threatening electrolyte imbalanceor rapidly rising, hard to control medically) Yes, Refractory severe metabolic acidosis life-threatening acid–base imbalance Yes, Refractory volume overload/pulmonary edema (diuretic-resistant) Yes, Uremic symptoms (encephalopathy/pericarditis/bleeding) or severe azotemia Yes, Dialyzable toxin/drug poisoning (e.g. lithium, methanol, ethylene glycol, salicylate) Yes, Hemodynamically unstable (needs vasopressors/brain injury/raised ICP) Yes → Result: RRT initiation Emergent indication present（Determination: Emergent indication present: refractory hyperkalemia, severe acidosis life-threatening acid–base imbalance, volume overload/pulmonary edema, uremia/severe azotemia, dialyzable poisoning → start renal replacement therapy, Modality choice: CRRT (continuous; preferred over intermittent hemodialysis when hemodynamically unstable/brain injury/raised ICP, reducing blood-pressure and ICP swings), Management direction: Start RRT promptly and correct triggers concurrently; hemodynamic instability favors CRRT, effluent dose 20–25 mL/kg/h; anticoagulation preferably regional citrate (if no contraindication)）