Critical care nurses’ experiences of managing patients receiving continuous kidney replacement therapy in intensive care units: a qualitative study in Saudi Arabia

BACKGROUND: Acute kidney injury requiring kidney replacement therapy is a common and life-threatening complication among critically ill patients. Continuous kidney replacement therapy (CKRT) is frequently used in haemodynamically unstable ICU patients and places substantial technical, cognitive, emotional, and relational demands on critical care nurses. Although nurses are central to CKRT delivery, limited qualitative evidence explores their lived experiences of providing technology-embedded kidney support in Middle Eastern ICU contexts. METHODS: A qualitative study using reflexive thematic analysis was conducted in adult ICUs affiliated with university healthcare settings in Al-Ahsa, Eastern Province, Saudi Arabia. Twenty critical care nurses with direct experience of caring for patients receiving CKRT or other kidney replacement therapies were recruited using purposive sampling. Semi-structured interviews were conducted face-to-face or through secure encrypted video conferencing, in Arabic, English, or bilingually according to participant preference. Interviews were audio-recorded, transcribed verbatim, translated where required, and analysed using Braun and Clarke's six-phase reflexive thematic analysis approach. RESULTS: Four interrelated themes were developed: (1) Caught between the machine and the person; (2) On the edge: the emotional weight of kidney failure in critical care; (3) A delicate balance: uncertainty, advocacy, and interprofessional dynamics; and (4) Growing through the challenge: competence-building and resilience. Nurses described CKRT as a form of technology-embedded relational care requiring simultaneous machine vigilance, humanistic presence, moral judgement, family support, and interprofessional advocacy. CONCLUSIONS: Managing patients receiving CKRT in ICUs requires more than technical competence. It involves emotionally intense, morally complex, and relationally significant nursing work. Structured CKRT education, simulation-based training, advocacy preparation, routine debriefing, psychological support, and staffing models that reflect CKRT workload are needed to sustain safe and person-centred critical kidney care. CLINICAL TRIAL REGISTRATION: Not applicable.