Practice patterns in the management of acute renal failure in the critically ill patient: an international survey

Abstract

New classifications such as RIFLE criteria might improve well-known uncertainty about ARF definition. Different RRT techniques are available in most centres, but a general lack of treatment dose standardization is noted by our survey. Non-renal indications to RRT still need to find a definitive role in routine practice.

Timing of Initiation and Discontinuation of Renal Replacement Therapy in AKI

“…T he provision of renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is extremely variable and based primarily on empiricism and local institutional practice and resources (1)(2)(3). In particular, there is little consensus on the indications for RRT in general, on the criteria to start RRT, on the appropriate time for initiation or regarding the timing for discontinuation.…”

“…In particular, there is little consensus on the indications for RRT in general, on the criteria to start RRT, on the appropriate time for initiation or regarding the timing for discontinuation. Criteria to define the need for RRT in AKI have been analyzed by the Acute Dialysis Quality Initiative in previous consensus conferences and publications (1)(2)(3) In general, it appears that the decision to start RRT is affected by strongly held physician beliefs in addition to patient characteristics and logistical or organizational aspects of a given institution. Patient characteristics may include age, severity of illness, and comorbidities (4,5).…”

Use of Peritoneal Dialysis in AKI

“…Extracorporeal blood purification (EBP) techniques such as continuous renal replacement therapy (CRRT) and intermittent hemodialysis (HD) are the most commonly used in the therapy of AKI in developed countries (2). There has, however, been renewed interest in the use of peritoneal dialysis (PD) in AKI (3,4).…”

Comparing Dialysis Modalities for Critically Ill Patients

“…The likely answer to all of these questions is a resounding, "No!" There is wide variation in dialysis care delivery worldwide, represented by a lack of any consensus on timing of initiation, dosage of dialysis, duration of therapy, standards for monitoring, training and performance assessments of caregivers, and industry standards for machine performance (1,9,10). Is it any wonder that we are unable to show any benefit in outcomes using these techniques?…”

“…Because the prescription and the care delivery are done by different people, knowledge deficits on the fundamentals of dialysis techniques, appropriate training, and performance monitoring are key areas to be addressed. Although CRRT techniques are inherently subject to more variation given the duration and that several caregivers handle the CRRT sessions, intermittent and hybrid techniques are not immune from these events (1,9). Variable knowledge and experience of the team may limit optimal care delivery, particularly when hand-off procedures are not well defined.…”