The Impact of Nurse-Led Continuous Renal Replacement Therapy Management on Clinical Outcomes in Adult Critically Ill Patients: A Systematic Review

Abstract

Introduction. Continuous renal replacement therapy (CRRT) is 
a cornerstone treatment for hemodynamically unstable critically 
ill patients with acute kidney injury (AKI). Despite technological 
advances, CRRT outcomes remain variable, and the impact of 
nursing leadership in CRRT delivery has not been sufficiently 
synthesized. This study aims to evaluate the effect of nurse-led 
CRRT management on clinical and treatment-related outcomes 
in adult critically ill patients.
Methods. A systematic review was conducted according to PRISMA 
2020 guidelines. PubMed/MEDLINE, Embase, Scopus, CINAHL, 
and the Cochrane Library were searched for studies involving 
adult ICU patients receiving CRRT where nurse-led management 
was explicitly described. Primary outcomes included mortality, 
circuit lifespan, and unplanned circuit interruption or clotting. 
Secondary outcomes included delivered CRRT dose, treatment 
downtime, and CRRT-related complications.
Results. Fifteen eligible studies were identified, including 
randomized and non-randomized designs evaluating nurse-led 
CRRT models compared with standard or physician-led care. 
Nurse-led CRRT management was associated with prolonged 
circuit lifespan and reduced unplanned interruptions in most 
studies. Mortality effects were variable. Heterogeneity across 
studies reflected differences in staffing models, protocols, and 
outcome definitions.
Conclusions. Nurse-led CRRT management appears to improve 
key treatment-related outcomes and care continuity in adult 
ICU patients. These findings have important implications for 
workforce development and care models, particularly in low- 
and middle-income countries (LMICs).