{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:56Z","timestamp":1786480316250,"version":"build-2736575974"},"reference-count":105,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U54DK137307"],"award-info":[{"award-number":["U54DK137307"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U54DK137307"],"award-info":[{"award-number":["U54DK137307"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute renal replacement therapy (RRT). Although we have accumulated data from thousands of critically ill patients with AKI randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities. These transition periods must be carefully navigated since they can be a source of complications, such as failure to transition or intradialytic hypotension, which are in turn associated with an increased risk of mortality and reduced odds of kidney recovery. In this review, we focus on the critical factors to consider during de-escalation of RRT care, with a focus on modality transition, the role of volume status in guiding the approach to de-escalation of RRT, and the vital importance of careful dosing of drugs, especially antimicrobial agents, during this transitional period.<\/jats:p>","DOI":"10.34067\/kid.0000000951","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T16:01:14Z","timestamp":1754668874000},"page":"1798-1809","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023\u20132024)"],"prefix":"10.34067","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3030-8703","authenticated-orcid":false,"given":"William","family":"Beaubien-Souligny","sequence":"first","affiliation":[{"name":"Division of Nephrology, Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al, Montreal, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8047-5978","authenticated-orcid":false,"given":"Melissa","family":"Thompson Bastin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-9644","authenticated-orcid":false,"given":"J. Pedro","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Divisions of Nephrology and Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-1697","authenticated-orcid":false,"given":"Jorge","family":"Cerda","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Albany Medical College, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7613-5583","authenticated-orcid":false,"given":"Michael J.","family":"Connor","sequence":"additional","affiliation":[{"name":"Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9501-8005","authenticated-orcid":false,"given":"Amanda","family":"Dijanic Zeidman","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Institute for Critical Care Medicine at Mount Sinai Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6016-4715","authenticated-orcid":false,"given":"Pranav S.","family":"Garimella","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4630-2747","authenticated-orcid":false,"given":"Luis","family":"Juncos","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8950-2087","authenticated-orcid":false,"given":"Arnaldo","family":"Lopez-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Critical Care, AdventHealth Orlando, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0908-2968","authenticated-orcid":false,"given":"Ravindra","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Diego (UCSD), San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7071-117X","authenticated-orcid":false,"given":"Thiago","family":"Reis","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9565-3976","authenticated-orcid":false,"given":"Lilia","family":"Rizo-Topete","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hospital Universitario \u201cDr. Jose Eleuterio Gonz\u00e1lez\u201d, UANL, Monterrey, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1843-6131","authenticated-orcid":false,"given":"Samuel A.","family":"Silver","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Queen's University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1142-1091","authenticated-orcid":false,"given":"J. 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