Existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial

Abstract

ObjectiveTo investigate the existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial.MethodsA questionnaire was provided to the chairs of 61 intensive care units enrolled in a randomized clinical trial in Brazil. A total of 124 physicians completed the questionnaire.ResultsApproximately 15% of the patients admitted to the analyzed intensive care units received renal replacement therapy at the time of data collection. At least one renal replacement method was available in all of the analyzed units. Continuous methods were available more frequently at the private units than at the public units. The time from indication to onset of treatment was longer at the public units than at private units. The main obstacles to treatment initiation at public intensive care units were related to the availability of equipment and personnel, while the main bottleneck at private units was the nephrologist assessment. A considerable proportion of the participants stated that they would change their approach to renal replacement therapy if there were no limitations on the availability of methods in their units.ConclusionThere was wide variation in the availability of resources for renal replacement therapy and in the management of acute kidney injury in Brazilian intensive care units. This information should be taken into account when planning clinical trials focused on this topic in Brazil.

Prioritization of ICU beds with renal replacement therapy support by court order and mortality in a Brazilian metropolitan area

“…Regardless of these limitations, our study showed that the variables applied by the Regulation Center that services the Federal District were able to triage patients with a higher chance to benefit from ICU-RRT admission, reinforcing the need for improvement in the ICU-RRT triage and rationing processes. Besides, the shortage of ICU resources, especially RRT support, is a critical problem in several countries, especially in those with a low- and middle-income 6 , 51 , 52 . In Brazil, the poorest or less-educated patients who depend exclusively on the public health system are the most affected, as most Brazilian middle- and higher-income residents have a private health insurance.…”

“…The shortage of intensive care unit (ICU) resources, including equipment and supplies for renal replacement therapy (RRT), is a critical problem in several countries 1 – 8 even before the COVID-19 pandemic, drawing attention to the limited capacity of resources in ICU settings worldwide 9 – 17 . The demand for ICU beds with RRT support (ICU-RRT) exceeding the available capacity is a crucial issue in Brazil, mainly in public hospitals, postponing ICU admission and the RRT initiation 6 and affecting outcomes, such as hospital length of stay and mortality 18 – 23 .…”