TY - JOUR
T1 - Continuous renal replacement therapy
T2 - A worldwide practice survey: The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators
AU - Uchino, Shigehiko
AU - Bellomo, Rinaldo
AU - Morimatsu, Hiroshi
AU - Morgera, Stanislao
AU - Schetz, Miet
AU - Tan, Ian
AU - Bouman, Catherine
AU - Macedo, Ettiene
AU - Gibney, Noel
AU - Tolwani, Ashita
AU - Oudemans-Van Straaten, Heleen
AU - Ronco, Claudio
AU - Kellum, John A.
PY - 2007/9/1
Y1 - 2007/9/1
N2 - Objective: Little information is available regarding current practice in continuous renal replacement therapy (CRRT) for the treatment of acute renal failure (ARF) and the possible clinical effect of practice variation. Design: Prospective observational study. Setting: A total of 54 intensive care units (ICUs) in 23 countries. Patients and participants: A cohort of 1006 ICU patients treated with CRRT for ARF. Interventions: Collection of demographic, clinical and outcome data. Measurements and results: All patients except one were treated with venovenous circuits, most commonly as venovenous hemofiltration (52.8%). Approximately one-third received CRRT without anticoagulation (33.1%). Among patients who received anticoagulation, unfractionated heparin (UFH) was the most common choice (42.9%), followed by sodium citrate (9.9%), nafamostat mesilate (6.1%), and low-molecular-weight heparin (LMWH; 4.4%). Hypotension related to CRRT occurred in 19% of patients and arrhythmias in 4.3%. Bleeding complications occurred in 3.3% of patients. Treatment with LMWH was associated with a higher incidence of bleeding complications (11.4%) compared to UFH (2.3%, p = 0.0083) and citrate (2.0%, p = 0.029). The median dose of CRRT was 20.4 ml/kg/h. Only 11.7% of patients received a dose of > 35 ml/kg/h. Most (85.5%) survivors recovered to dialysis independence at hospital discharge. Hospital mortality was 63.8%. Multivariable analysis showed that no CRRT-related variables (mode, filter material, drug for anticoagulation, and prescribed dose) predicted hospital mortality. Conclusions: This study supports the notion that, worldwide, CRRT practice is quite variable and not aligned with best evidence.
AB - Objective: Little information is available regarding current practice in continuous renal replacement therapy (CRRT) for the treatment of acute renal failure (ARF) and the possible clinical effect of practice variation. Design: Prospective observational study. Setting: A total of 54 intensive care units (ICUs) in 23 countries. Patients and participants: A cohort of 1006 ICU patients treated with CRRT for ARF. Interventions: Collection of demographic, clinical and outcome data. Measurements and results: All patients except one were treated with venovenous circuits, most commonly as venovenous hemofiltration (52.8%). Approximately one-third received CRRT without anticoagulation (33.1%). Among patients who received anticoagulation, unfractionated heparin (UFH) was the most common choice (42.9%), followed by sodium citrate (9.9%), nafamostat mesilate (6.1%), and low-molecular-weight heparin (LMWH; 4.4%). Hypotension related to CRRT occurred in 19% of patients and arrhythmias in 4.3%. Bleeding complications occurred in 3.3% of patients. Treatment with LMWH was associated with a higher incidence of bleeding complications (11.4%) compared to UFH (2.3%, p = 0.0083) and citrate (2.0%, p = 0.029). The median dose of CRRT was 20.4 ml/kg/h. Only 11.7% of patients received a dose of > 35 ml/kg/h. Most (85.5%) survivors recovered to dialysis independence at hospital discharge. Hospital mortality was 63.8%. Multivariable analysis showed that no CRRT-related variables (mode, filter material, drug for anticoagulation, and prescribed dose) predicted hospital mortality. Conclusions: This study supports the notion that, worldwide, CRRT practice is quite variable and not aligned with best evidence.
KW - Acute renal failure
KW - Continuous renal replacement therapy
KW - Critical illness
KW - Epidemiology
KW - Heparin
KW - Low-molecular-weight heparin
UR - http://www.scopus.com/inward/record.url?scp=34548161674&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00134-007-0754-4
DO - https://doi.org/10.1007/s00134-007-0754-4
M3 - Article
C2 - 17594074
SN - 0342-4642
VL - 33
SP - 1563
EP - 1570
JO - Intensive care medicine
JF - Intensive care medicine
IS - 9
ER -