Pharmacy to Dose: The Critical Care Podcast CRRT Trials of the Week: RENAL & IDEAL-ICU
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Oct 31, 2023 Linda Awdishu, a clinical pharmacy professor specializing in renal replacement therapy, dives into the critical role of continuous renal replacement therapy (CRRT) in the ICU. She discusses groundbreaking studies like RENAL and IDEAL-ICU, revealing no mortality benefit from higher intensity CRRT and the timing for initiating therapy. Linda emphasizes the necessity for pharmacists to accurately dose antibiotics based on delivered effluent rates. The conversation also explores future research priorities, including AI guidance and improved interdisciplinary collaboration.
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Why CRRT Suits Unstable Patients
- CRRT uses much lower blood flow rates (≈100–150 mL/min) enabling treatment of hemodynamically unstable patients. This slower extracorporeal flow is a key reason CRRT tolerability differs from intermittent hemodialysis.
Effluent Flow Rate Defines CRRT Dose
- The CRRT
RENAL Trial: No Mortality Benefit
- RENAL randomized CVVHDF patients to ~25 versus 40 mL/kg/hr effluent and used 90-day mortality as the primary outcome. The trial found no mortality benefit to higher intensity CRRT and flagged more renal dependence at day 90 with higher intensity.