Complications of Renal Replacement Therapy (RRT) and Their Management 

Haemodynamic Instability 

Cause: Rapid fluid shifts and ultrafiltration, especially in critically ill or hypotensive patients. 
Clinical Features: Hypotension, tachycardia, dizziness, decreased organ perfusion. 
Prevention: Use slow continuous RRT (CRRT), gradual ultrafiltration, optimize preload. 
Management: Reduce ultrafiltration rate, administer vasopressors, use cool dialysate, monitor BP closely. 

Air Emboli 

Cause: Air entering the extracorporeal circuit. 
Clinical Features: Sudden hypotension, dyspnea, chest pain, neurological deficits. 
Prevention: Proper circuit priming, secure connections, use air detectors. 
Management: Stop RRT, clamp circuit, position patient left lateral decubitus with Trendelenburg, administer 100% oxygen, consider hyperbaric therapy. 

Platelet Consumption / Thrombocytopenia 

Cause: Platelet activation in extracorporeal circuit, HIT. 
Clinical Features: Falling platelet counts, bleeding tendency. 
Prevention: Use biocompatible membranes, monitor platelet counts, consider citrate anticoagulation. 
Management: Stop heparin if HIT suspected, replace platelets if needed, switch to alternative anticoagulation. 

Blood Loss 

Cause: Circuit disconnection, haemolysis, repeated blood sampling. 
Clinical Features: Drop in haemoglobin, hypotension, pallor. 
Prevention: Secure connections, minimise sampling, use blood conservation strategies. 
Management: Transfuse RBCs, correct bleeding source, monitor haemoglobin and haemodynamics. 

Electrolyte Imbalances 

Cause: Rapid shifts during dialysis. 
Clinical Features: Hypo/hyperkalemia, hypophosphatemia, hypo/hypernatremia, hypocalcemia. 
Prevention: Tailor dialysate composition, frequent electrolyte monitoring. 
Management: Replace deficient electrolytes, adjust dialysate prescription, manage hyperkalemia medically. 

Hypothermia 

Cause: Blood cooled in extracorporeal circuit. 
Clinical Features: Shivering, bradycardia, coagulopathy, arrhythmias. 
Prevention: Use blood warmers, warmed dialysate, monitor core temperature, cover patient. 
Management: Gradual rewarming, external warming devices, adjust machine temperature. 

Heparin-Induced Bleeding / HIT 
Cause: Systemic heparin anticoagulation. 
Clinical Features: Unexpected bleeding, declining platelets, thrombosis. 
Prevention: Use citrate anticoagulation, monitor aPTT and platelets, avoid heparin in HIT patients. 
Management: Stop heparin, use non-heparin anticoagulants (argatroban, fondaparinux), supportive care for bleeding. 

Summary Table: