Comparison of vascular access routes for continuous renal replacement therapy – Full Text

Continuous renal replacement therapy (CRRT) is a widely used treatment modality for critically ill patients with acute kidney injury. The choice of vascular access route is a critical factor in determining the effectiveness of CRRT and its effects on hemodynamic stability. This study aimed to compare the effectiveness and hemodynamic effects of CRRT via the internal jugular vein (IJV) and femoral vein (FV). A total of 102 patients admitted to the intensive care unit who required CRRT were included in this prospective cohort study. Patients were divided into the IJV group and FV group based on the vascular access route used. Hemodynamic parameters (heart rate, systolic, diastolic, and mean arterial pressure), vasopressor requirements, and the effectiveness of CRRT (urea clearance) were evaluated at the onset of CRRT, and at 1 minute, 60 minutes, and 24 hours. There were no significant intergroup differences in demographics, baseline hemodynamic parameters, or CRRT settings. However, vasopressor requirements were significantly higher in the FV group at 24 hours (P = .035). Urea clearance was significantly higher in the IJV group compared to the FV group at 60 minutes (28.3 ± 7.15 mL/min vs 25.53 ± 4.87 mL/min, P = .036), though there was no significant intergroup difference at 24 hours. There were no significant intergroup differences in filter lifespan. The application of CRRT via IJV or FV was not associated with significant hemodynamic instability. However, the FV access route was associated with a higher vasopressor requirement, suggesting potential hemodynamic disadvantages. Furthermore, IJV access was associated with better urea clearance during the early period. These results highlight the importance of vascular access route selection in CRRT and underscore the need for further studies involving larger patient groups.

Firat A, Akbulut M, Özdemir Ö, Toptaş Firat B. Jugular vein or femoral vein? A comparison of vascular routes based on effectiveness and hemodynamic effects of continuous renal replacement therapy. Medicine (Baltimore). 2026 Jan 9;105(2):e47077. doi: 10.1097/MD.0000000000047077. PMID: 41517722; PMCID: PMC12795071.