Clinical Monitoring of Pediatric and Adolescent Patients Undergoing Continuous Renal Replacement Therapy (CRRT)

Continuous renal replacement therapy (CRRT) is a vital life-sustaining modality for managing acute kidney injury (AKI) and fluid overload in hemodynamically unstable pediatric, adolescent, and adult patients. This comprehensive review outlines the critical aspects of CRRT monitoring, including pre-CRRT preparation, modality selection, dose calculation, vascular access, and real-time parameter tracking. The document emphasizes the importance of individualized dosing strategies tailored by age, body size, and metabolic needs, particularly in children. Detailed guidance is provided on blood flow rates, dialysate and ultrafiltration settings, anticoagulation choices, and filter selection based on patient weight and extracorporeal volume. Monitoring during CRRT includes the frequent assessment of hemodynamic status, laboratory markers, nutritional status, and infection risk. Daily interdisciplinary coordination among nephrologists, intensivists, nurses, and pharmacists is highlighted as a key component of successful CRRT implementation. Pediatric-specific considerations such as the use of pre- and post-filter weight scales and sensitivity to fluid shifts are discussed. The document provides practical strategies and checklists aimed at optimizing patient safety, therapy efficacy, and clinical outcomes in both pediatric and adult critical care settings.