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 Bellomo, 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

Research output: Contribution to journalArticle

321 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1563-1570
Number of pages8
JournalIntensive Care Medicine
Volume33
Issue number9
DOIs
Publication statusPublished - Sep 2007
Externally publishedYes

Fingerprint

Renal Replacement Therapy
Research Personnel
Kidney
Low Molecular Weight Heparin
Hospital Mortality
Acute Kidney Injury
Therapeutics
Intensive Care Units
Heparin
Hemorrhage
Hemofiltration
Surveys and Questionnaires
Citric Acid
Hypotension
Observational Studies
Survivors
Cardiac Arrhythmias
Dialysis
Demography
Prospective Studies

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Continuous renal replacement therapy : A worldwide practice survey: The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators. / Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Oudemans-Van Straaten, Heleen; Ronco, Claudio; Kellum, John A.

In: Intensive Care Medicine, Vol. 33, No. 9, 09.2007, p. 1563-1570.

Research output: Contribution to journalArticle

Uchino, S, Bellomo, R, Morimatsu, H, Morgera, S, Schetz, M, Tan, I, Bouman, C, Macedo, E, Gibney, N, Tolwani, A, Oudemans-Van Straaten, H, Ronco, C & Kellum, JA 2007, '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 Medicine, vol. 33, no. 9, pp. 1563-1570. https://doi.org/10.1007/s00134-007-0754-4
Uchino, Shigehiko ; Bellomo, Rinaldo ; Morimatsu, Hiroshi ; Morgera, Stanislao ; Schetz, Miet ; Tan, Ian ; Bouman, Catherine ; Macedo, Ettiene ; Gibney, Noel ; Tolwani, Ashita ; Oudemans-Van Straaten, Heleen ; Ronco, Claudio ; Kellum, John A. / Continuous renal replacement therapy : A worldwide practice survey: The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators. In: Intensive Care Medicine. 2007 ; Vol. 33, No. 9. pp. 1563-1570.
@article{91d322a9547a4250b4cb2cfbb20152a3,
title = "Continuous renal replacement therapy: A worldwide practice survey: The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators",
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, Continuous renal replacement therapy, Critical illness, Epidemiology, Heparin, Low-molecular-weight heparin",
author = "Shigehiko Uchino and Rinaldo Bellomo and Hiroshi Morimatsu and Stanislao Morgera and Miet Schetz and Ian Tan and Catherine Bouman and Ettiene Macedo and Noel Gibney and Ashita Tolwani and {Oudemans-Van Straaten}, Heleen and Claudio Ronco and Kellum, {John A.}",
year = "2007",
month = "9",
doi = "10.1007/s00134-007-0754-4",
language = "English",
volume = "33",
pages = "1563--1570",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "9",

}

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

Y1 - 2007/9

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

UR - http://www.scopus.com/inward/citedby.url?scp=34548161674&partnerID=8YFLogxK

U2 - 10.1007/s00134-007-0754-4

DO - 10.1007/s00134-007-0754-4

M3 - Article

C2 - 17594074

AN - SCOPUS:34548161674

VL - 33

SP - 1563

EP - 1570

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 9

ER -