• William R Clark, Mauro Neri, Francesco Garzotto, Zaccaria Ricci, Stuart L Goldstein, Xiaoqiang Ding, Jiarui Xu, and Claudio Ronco.
• School of Chemical Engineering, Purdue University, 480 Stadium Mall Drive; FRNY 1051, West Lafayette, IN, 47907, USA. clarkw@purdue.edu.
• Crit Care. 2017 Apr 11; 21 (1): 92.

AbstractSince its inception four decades ago, both the clinical and technologic aspects of continuous renal replacement therapy (CRRT) have evolved substantially. Devices now specifically designed for critically ill patients with acute kidney injury are widely available and the clinical challenges associated with treating this complex patient population continue to be addressed. However, several important questions remain unanswered, leaving doubts in the minds of many clinicians about therapy prescription/delivery and patient management. Specifically, questions surrounding therapy dosing, timing of initiation and termination, fluid management, anticoagulation, drug dosing, and data analytics may lead to inconsistent delivery of CRRT and even reluctance to prescribe it. In this review, we discuss current limitations of CRRT and potential solutions over the next decade from both a patient management and a technology perspective. We also address the issue of sustainability for CRRT and related therapies beyond 2027 and raise several points for consideration.

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