Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators

Intensive Care Med. 2007 Sep;33(9):1563-70. doi: 10.1007/s00134-007-0754-4. Epub 2007 Jun 27.

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / therapy*
  • Aged
  • Anticoagulants / therapeutic use
  • Arrhythmias, Cardiac / epidemiology
  • Citrates / therapeutic use
  • Drug Utilization / statistics & numerical data*
  • Female
  • Guanidines / therapeutic use
  • Hemorrhage / epidemiology
  • Heparin / therapeutic use
  • Hospital Mortality
  • Humans
  • Hypotension / epidemiology
  • Intensive Care Units
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Recovery of Function
  • Renal Replacement Therapy / adverse effects
  • Renal Replacement Therapy / methods
  • Renal Replacement Therapy / statistics & numerical data*
  • Sodium Citrate

Substances

  • Anticoagulants
  • Citrates
  • Guanidines
  • Sodium Citrate
  • Heparin
  • nafamostat