This study will test whether patients who already have a permanent dialysis access (an arteriovenous fistula or graft) can safely use that access for continuous dialysis (CRRT) while they are critically ill in the intensive care unit, instead of requiring a temporary central venous catheter. About 50 patients will participate. Researchers will monitor how well the access works, whether any complications occur, and whether there are differences between fistulas and grafts. The goal is to determine whether using a patient's existing dialysis access is a safe and practical option that could reduce the need for temporary catheters and their associated risks, such as infection and bleeding.
Age ≥18 years.
ESKD patients on chronic hemodialysis for >1 year in duration who are admitted to the ICU and in need of CRRT.
Anticipated CRRT duration ≥24 hours, based on clinical assessment of the renal trajectory.
Patient with functioning arteriovenous access, either arteriovenous fistula or arteriovenous graft.
Age less than 18 years old.
Patients who receive dialysis via hemodialysis catheter or existing central catheter suitable for hemodialysis.
ESKD patients who, at the time of enrollment, have a sacral pressure ulcer or other clinically significant skin integrity impairment requiring frequent repositioning, extensive patient rotation, or advanced wound care management.
Patients with elevated INR above 5 at the time of study enrollment.