Overview, Technical Aspects, and Safety of RRT Modalities in Critical Care

Acute kidney injury (AKI) is highly prevalent in critical care settings. When severe electrolyte and acid-base imbalances cannot be corrected through medical therapy, renal replacement therapy (RRT) becomes a crucial intervention. The availability of RRTs varies according to local center policies and available technology, encompassing intermittent, hybrid, and continuous therapies, with continuous therapy being the most commonly used for unstable patients in critical care areas. The choice of RRT modality primarily depends on the patient’s hemodynamic status, and each type of RRT differs in prescription parameters and indications. Clinicians must consider the multitude of life-threatening risks and complications associated with RRT when deciding to prescribe it. These risks can occur during vascular access placement (e.g., bleeding, pneumothorax, infection, thrombosis) and during RRT delivery (e.g., hemodynamic instability, arrhythmias, prolonged exposure to anticoagulation). The RRT prescription and delivery process involves the collaboration of various caregivers (nephrologists, intensivists, dialysis nurses, intensive care nurses) in a multidisciplinary approach that carries a high risk of medical errors, potentially compromising patient safety. To mitigate the risk of errors and enhance patient safety, strict adherence to predefined protocols and the adoption of effective and unambiguous means of communication are essential. These measures can help reduce the propagation of errors and minimize the clinical risks associated with RRT implementation.