Continuous renal replacement therapy (CRRT) is essential for critically ill pediatric patients with acute kidney injury, severe fluid overload, or metabolic emergencies. Yet opportunities for trainees to meaningfully practice CRRT decision-making are rare, particularly in pediatrics, due to variations in institutional case volume, the rarity of certain presentations, and the high cost and resource demands of in-person simulation.
As a pediatric nephrologist and education researcher, I wanted to create an accessible, risk-free way for learners to practice CRRT prescriptions and troubleshooting. This led to the Virtual Pediatric CRRT Simulator – a free, browser-based tool designed for nephrology and critical care trainees worldwide.
What Need Does This Fill?
The simulator addresses three key barriers to CRRT training:
- Limited bedside opportunities – especially in pediatric centers with low case volumes.
- High-stakes learning environment – where mistakes have real patient consequences.
- Inconsistent exposure – with some trainees encountering only narrow case types during training
The goal was to offer a low-barrier, competency-based supplement that complements, but does not replace, institutional teaching and protocols.
How It Works
The simulator is interactive and case-based. Users begin with a fundamentals case covering the building blocks of CRRT prescription. As they complete cases successfully, new scenarios unlock, each focusing on a specific theme such as:
- Anticoagulation selection and troubleshooting
- Optimizing clearance in challenging patients
- Troubleshooting machine alarms
- Managing metabolic abnormalities
For those wanting a more tailored experience, an adaptive learning mode can be activated at any time. When enabled, the simulator dynamically generates targeted cases based on areas where the learner has struggled, reinforcing specific knowledge gaps.
Key Features
- Performance tracking via a report card view
- SI vs. non-SI units toggle for international usability
- Generic vs. brand-name equipment toggle for familiarity across regions
- Fully mobile and desktop compatible (optimal on desktop)
- Free, open-access, with no logins, downloads, ads, or commercial affiliations
Example of a case based scenario
A patient’s CRRT circuit has a drop in their BP – should you change your fluid removal goal? Did you consider your choice of priming solution? Could it be an issue with your anticoagulation? The simulator provides the learner with realistic cases, showing the downstream impact of each decision.
Try It Out
The simulator is freely available at: https://crrt-sim.netlify.app/
Feedback can be submitted directly within the platform, and future updates will expand the case library and refine features based on user suggestions.
What’s Next
I plan to add more advanced cases – including use of tandem therapies and nuanced hemodynamic scenarios – while continuing to refine the adaptive learning engine. The aim is for this to be a living, evolving resource that supports pediatric nephrology and ICU trainees worldwide in building CRRT competency.
Written by: Amrit Kirpalani, M.D., MEHP, FRCPC
Reviewed by: Arrsh Bajaj, M.D. and Matthew Sparks, M.D.
