Beyond the usual: A focus on infrequent complications of CRRT

Continuous renal replacement therapy (CRRT) is a cornerstone in the management of critically ill patients with acute kidney injury and fluid-electrolyte disturbances. While widely adopted and considered safe, CRRT is not exempt from complications—some of which, though infrequent, can have serious consequences for patient outcomes and circuit performance. In this review, we present a focused analysis of underrecognized but clinically relevant complications associated with CRRT, including hypertriglyceridemia-related circuit failure, euglycemic ketoacidosis, cold agglutinin-mediated filter clotting, hypophosphatemia-induced weaning failure, hypothermia, and citrate-induced magnesium depletion. Each section highlights the pathophysiology, risk factors, clinical implications, and preventive strategies for these events. Notably, we emphasize the importance of early recognition and targeted monitoring, as many of these complications may develop silently or mimic more common issues. Practical recommendations are provided to guide clinicians in optimizing CRRT delivery and minimizing the risk of adverse events. By shedding light on these rare complications, we aim to improve awareness, encourage proactive surveillance, and ultimately enhance the safety and effectiveness of extracorporeal therapy in critical care settings.