Episode 206: CRRT in the ICU with Derek Fine

In this episode of ACCRAC, host Jed Wolpaw interviews Dr. Derek Fine, a nephrologist, about continuous renal replacement therapy (CRRT) in the ICU. They discuss the different types of CRRT, including CVVHD and CVVHF, and differentiate between dialysis and ultrafiltration. Dr. Fine explains the indications for CRRT versus intermittent dialysis, focusing on patients who cannot tolerate large fluid shifts due to hypotension or brain edema. The conversation covers catheter types, placement, and troubleshooting clotting issues, as well as the use of anticoagulation. They delve into the debate of early versus late initiation of CRRT and the importance of individualized patient assessment. Dr. Fine also shares insights on managing electrolyte imbalances, monitoring protein levels, and adjusting CRRT variables. The episode concludes with a discussion on determining when a patient is ready to come off CRRT and a brief look at potential future developments in renal replacement therapy.