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Intensive Care Medicine

, Volume 33, Issue 9, pp 1563–1570 | Cite as

Continuous renal replacement therapy: A worldwide practice survey

The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators
  • Shigehiko Uchino
  • Rinaldo BellomoEmail author
  • Hiroshi Morimatsu
  • Stanislao Morgera
  • Miet Schetz
  • Ian Tan
  • Catherine Bouman
  • Ettiene Macedo
  • Noel Gibney
  • Ashita Tolwani
  • Heleen Oudemans-van Straaten
  • Claudio Ronco
  • John A. Kellum
Original

Abstract

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.

Keywords

Acute renal failure Critical illness Continuous renal replacement therapy Epidemiology Heparin Low-molecular-weight heparin 

Supplementary material

134_2007_754_MOESM1_ESM.doc (75 kb)
Electronic Supplementary Material (DOC 75K)
134_2007_754_MOESM2_ESM.doc (54 kb)
Electronic Supplementary Material (DOC 55K)

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Shigehiko Uchino
    • 1
  • Rinaldo Bellomo
    • 2
    Email author
  • Hiroshi Morimatsu
    • 2
  • Stanislao Morgera
    • 3
  • Miet Schetz
    • 4
  • Ian Tan
    • 5
  • Catherine Bouman
    • 6
  • Ettiene Macedo
    • 7
  • Noel Gibney
    • 8
  • Ashita Tolwani
    • 9
  • Heleen Oudemans-van Straaten
    • 10
  • Claudio Ronco
    • 11
  • John A. Kellum
    • 12
  1. 1.Intensive Care Unit, Department of AnesthesiologyJikei University School of MedicineTokyoJapan
  2. 2.Department of Intensive Care and Department of MedicineAustin HospitalMelbourneAustralia
  3. 3.Department of NephrologyUniversity hospital CharitéBerlinGermany
  4. 4.Dienst Intensieve GeneeskundeUniversitair Ziekenhuis GasthuisbergLeuvenBelgium
  5. 5.Dept of Intensive Care MedicineSingapore General HospitalSingaporeSingapore
  6. 6.Adult Intensive Care UnitAcademic Medical CenterAmsterdamThe Netherlands
  7. 7.Nephrology DivisionUniversity of São Paulo School of MedicineSão PauloBrazil
  8. 8.Division of Critical Care MedicineUniversity of AlbertaEdmontonCanada
  9. 9.Department of Medicine, Division of NephrologyThe University of AlabamaBirminghamUSA
  10. 10.Intensive Care UnitOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  11. 11.Nephrology – Intensive CareSt. Bortolo HospitalVicenzaItaly
  12. 12.Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA

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