The Impact of Nurse-Led Continuous Renal Replacement Therapy Management on Clinical Outcomes in Adult Critically Ill Patients: A Systematic Review

Introduction. Continuous renal replacement therapy (CRRT) is a cornerstone treatment for hemodynamically unstable critically ill patients with acute kidney injury (AKI). Despite technological advances, CRRT outcomes remain variable, and the impact of nursing leadership in CRRT delivery has not been sufficiently synthesized. This study aims to evaluate the effect of nurse-led CRRT management on clinical and treatment-related outcomes in adult critically ill patients.Methods. A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library were searched for studies involving adult ICU patients receiving CRRT where nurse-led management was explicitly described. Primary outcomes included mortality, circuit lifespan, and unplanned circuit interruption or clotting. Secondary outcomes included delivered CRRT dose, treatment downtime, and CRRT-related complications.Results. Fifteen eligible studies were identified, including randomized and non-randomized designs evaluating nurse-led CRRT models compared with standard or physician-led care. Nurse-led CRRT management was associated with prolonged circuit lifespan and reduced unplanned interruptions in most studies. Mortality effects were variable. Heterogeneity across studies reflected differences in staffing models, protocols, and outcome definitions.Conclusions. Nurse-led CRRT management appears to improve key treatment-related outcomes and care continuity in adult ICU patients. These findings have important implications for workforce development and care models, particularly in low- and middle-income countries (LMICs).