Would you increase the delivered dose to more than 25 ml/kg/hr in a patient on CKRT if a prolonged interruption for a procedure is planned for the day?

Guidelines, all guidelines have to be taken with a grain of salt. The Ronco CVVH trial found 35 ml/kg/hr was the goal, definitively. It was questioned because it was a single center with too many surgical patients. Is that really such a valid criticism? Not to be ignored, his study was pure post-dilution HF, all convective, none of those following that were pure HF. So the ATN NIH trial and the RENAL Australia NZ trials were done. ATN found that 20 ml/kg/hr was the cutoff (actually, it may have been lower but > 20 did not improve survival, and the cutoff in RENAL was 25 ml/kg/hr. 25 was picked as the goal, taking into account time off therapy to make sure you get 20. So, 20 or 25 or 35? Do we really think it matters? Of course, but pretendi...

I often base my CRRT prescription not on weight but on serum electrolytes. I would increase the dose of CRRT if the patient is acidotic/hyperkalemic/etc. and decrease the dose if the phosphorus is low.

Randomized trials have not demonstrated a benefit of high-dose CKRT vs lower-dose CKRT (20-25 ml/kg/hr). I typically prescribe a dose of 25-30 ml/kg/hr to give some cushion so that the delivered dose is at least 20-25 ml/kg/hr in the event of interruptions due to radiology studies, filter clotting, etc. So I don't make adjustments for these minor interruptions. However, if a patient is off for more than 4 hours, such as for surgery, then I do increase the dose to make up for the lost clearance.