Slow continuous ultrafiltration and prolonged intermittent renal replacement therapy: Tailoring renal replacement therapy in intensive care unit

Table 2 Standardized slow continuous ultrafiltration prescription

Standardized slow continuous ultrafiltration prescription
Modality	Slow continuous ultrafiltration
Indication	Fluid overload without need for solute clearance (preserved renal function or adequate clearance)
Duration	Continuous 24 hours or until target fluid removal achieved
Blood flow	150 mL/minute
Replacement fluid	0 mL/hour (none)
Dialysate flow	0 mL/hour (none)
Ultrafiltration rate	200 mL/hour (adjust 100-500 mL/hour based on clinical needs)
Net fluid removal target	-3 to -5 kg over 24-48 hours (or until euvolemia achieved)
Anticoagulation	Option 1: Heparin (activated partial thromboplastin time 45-60 sec or anti-Xa 025-0.35 U/mL). Option 2: None (if contraindicated - use higher blood flow rate 200 mL/minute). Option 3: Citrate regional (if available and trained staff)
Vascular access	Double-lumen dialysis catheter (11.5-13 Fr). Preferred sites: Internal jugular > femoral > subclavian
Filter	Standard hemofilter 1.0-1.5 m2 surface area
Monitoring	Blood pressure: Every 30-60 minutes. Fluid balance: Hourly. Weight: Every 12 hours. Electrolytes: Baseline, then every 12 hours. TMP (transmembrane pressure): Continuous. Clinical assessment: Volume status, lung auscultation every 4-6 hours
Adjustments	Increase UF rate if persistent overload and hemodynamically stable. Decrease UF rate if hypotension or signs of hypovolemia. Stop if hemodynamic instability despite fluid resuscitation. Monitor for hemoconcentration (hematocrit rise > 5%)
Special considerations	Cirrhosis: Use lower UF rates (50-150 mL/hour) + albumin replacement (8-10 g per 2-3 L removed). Heart failure: Monitor BNP, consider lower UF rates initially. Post-operative: Avoid anticoagulation if recent surgery

TMP: Transmembrane pressure; UF: Ultrafiltration; BNP: B-type natriuretic peptide.