Prolonged intermittent renal replacement therapy (PIRRT) is a hybrid kidney replacement modality positioned between intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). By extending the treatment duration of each session while lowering blood and dialysate/replacement fluid flow rates, PIRRT provides hemodynamic tolerability comparable to that of CRRT while preserving the intermittent nature of IHD. To standardize the clinical application of PIRRT in China, a multidisciplinary panel of experts in nephrology, critical care medicine, clinical pharmacy and pediatric nephrology developed this consensus based on a systematic literature review, evidence grading and multiple rounds of modified Delphi consultations. Recommendations cover terminology and definitions, indications and contraindications, equipment and parameter settings, vascular access, anticoagulation strategies, antimicrobial dose adjustment, and the prevention and management of complications. Specific guidance is provided on criteria for assessing hemodynamic stability, ultrafiltration rate control, the use of bedside PIRRT in maintenance hemodialysis (MHD) patients, nafamostat mesylate (NM) anticoagulation, and reference ranges for therapeutic drug monitoring of antimicrobials. This consensus aims to provide systematic, practical and evidence-based guidance for the standardized implementation of PIRRT in medical institutions at different levels, thereby improving treatment safety and effectiveness and ultimately improving outcomes in patients with severe kidney disease.