What is the evidence-based CRRT dose target?

Two landmark trials — ATN (Palevsky et al., NEJM 2008) and RENAL (Bellomo et al., NEJM 2009) — established that a CRRT effluent dose of 20–25 mL/kg/h is equivalent to higher doses (35–40 mL/kg/h) in terms of survival and renal recovery. KDIGO and SCCM guidelines recommend prescribing 20–25 mL/kg/h. Because circuit downtime reduces delivered dose, prescribing 25–30 mL/kg/h is often necessary to achieve a delivered dose of 20–25 mL/kg/h.

How should CRRT anticoagulation affect dosing calculations?

Regional citrate anticoagulation (RCA) is the preferred method for CRRT anticoagulation (KDIGO recommendation) — it reduces circuit clotting and extends filter life without systemic anticoagulation risk. With RCA, citrate infusion and calcium replacement rates are weight-based and must be incorporated into the total fluid balance calculation. Systemic heparin remains an alternative; its effects on clearance are negligible, but monitoring APTT and adjusting dose to maintain activated clotting time 180–220 seconds is required.

CRRT Dose Calculator

Calculate continuous renal replacement therapy (CRRT) dose (effluent rate in mL/kg/h) for patients with acute kidney injury requiring continuous dialysis in the ICU.

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Frequently Asked Questions

What is the evidence-based CRRT dose target?

How should CRRT anticoagulation affect dosing calculations?