Dose Prescription in Renal Replacement Therapy

The assessment of prescribed and delivered doses in continuous renal replacement therapy (CRRT) has become integral in the management of critically ill patients with acute kidney injury (AKI). This chapter delves into the evolution of dosing concepts, from the historical roots in chronic hemodialysis to the adaptation for critically ill AKI patients. The landmark Vicenza trial established effluent-based dosing as a pivotal factor, leading to improved survival rates with higher doses. However, subsequent randomized controlled trials and systematic reviews yielded inconsistent results, raising questions about the optimal CRRT dose. A critical consideration in understanding CRRT dosing is the therapy-specific nature of solute clearance, especially in post-dilution continuous venovenous hemofiltration (CVVH). Factors such as hemoconcentration and filter performance influence the relationship between effluent rate and solute clearance. In conclusion, this chapter provides a comprehensive update on CRRT dosing, considering recent developments and highlighting the dynamic nature of dosing in response to the evolving clinical status of critically ill AKI patients. It emphasizes that CRRT dosing is just one facet of overall therapy delivery, calling for a holistic approach in the pursuit of precision CRRT.