Clinical practice guideline for renal replacement therapy in critically ill patients with acute kidney injury (2026 edition).

Acute kidney injury (AKI) is a common and severe complication in critically ill patients, associated with high morbidity and mortality. Renal replacement therapy (RRT) is a vital life-support modality for critically ill patients with AKI. However, there remains a lack of unified clinical standards for core issues including the timing of RRT initiation, treatment modality, anticoagulation strategy, and weaning from RRT. In response, the Chinese Society of Critical Care Medicine organized a multidisciplinary expert panel to develop the "Clinical practice guideline for RRT in critically ill patients with AKI (2026 edition)" in accordance with the GRADE approach for grading evidence quality. This guideline was developed through systematic literature retrieval, meta-analysis, and evidence-based medical evidence synthesis, followed by multiple rounds of manuscript review and revision via online and offline meetings of the working group, and final approval by the Standing Committee of the Society. A total of 34 recommendations were finalized, covering key clinical topics including timing of RRT initiation, establishment and maintenance of vascular access, selection of treatment modalities, application of specialized membrane filters, anticoagulation regimens, replacement fluid formulations, prescribed treatment dose, and RRT weaning strategies. This guideline aims to provide scientific, standardized, and clinically actionable guidance for critical care practitioners in China, promoting standardized RRT management in adult critically ill patients with AKI.