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Introduction: The KDIGO clinical practice guideline recommends administering an effluent volume of 20–25 mL/kg/h during continuous renal replacement therapy (CRRT) for acute kidney injury (AKI). Recent evidence on CRRT initiation showed that less intervention might be beneficial for renal recovery. This study aimed to explore the association between early-phase low CRRT intensity and acid-base balance corrections and clinical outcomes. Methods: This was a single-centre, retrospective, observational study at a tertiary ICU in Japan. All adult patients requiring CRRT in the ICU were included. Eligible patients were classified into the Low group (Dialysate flow rate, QD 10.0-19.9 mL/kg/h) and the Standard group (QD ≥ 20 mL/kg/h) by the intensity of CRRT at the beginning. The primary outcomes were the changes in the acid-base parameters 6 hours after CRRT initiation. We used an inversed probability of treatment weighting analysis to estimate the association between the intensity group and the outcomes. Results: Overall, 194 patients were classified into the Low group (n = 144) and the Standard group (n = 50). Standard group presented with more severe acid-base disturbances, including lower pH and BE at baseline. At 6 hours after CRRT initiation, pH, BE, and SID values were comparable, even after adjusting for baseline severity. Despite the efficient correction, no evident differences were observed in clinical outcomes between the two groups. Conclusions: The initial standard intensity appeared to be efficient in correcting acid-base imbalance at the early phase of CRRT; however, further studies are needed to assess the impact on clinical outcomes.

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