Renal replacement therapy for acute renal failure: a survey of practice in adult intensive care units in the United Kingdom

Gatward, Jonathan; Gibbon, Grace; Wrathall, G.; Padkin, Andrew

doi:10.1111/j.1365-2044.2008.05514.x

Cited by 54 publications

(42 citation statements)

References 29 publications

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“…[17] In a similar survey in the UK in 2007, 65% of the units used continuous veno-venous hemofiltration as the first-line therapy, while 31% of the units used continuous veno-venous hemodiafiltration. [10] A major difference of these studies with our report is that the above studies have used facilities surveys assuming homogeneity across different populations. Our results determined the modality of RRT for AKI using claims billing and demonstrate that the greatest use of CRRT occurred in 2005, accounting for 18.3% of RRT for AKI.…”

Section: Discussionmentioning

confidence: 85%

“…In the United Kingdom, up to 65% of AKI patients are treated with continuous veno-venous hemofiltration as first line therapy. [10] Similarly, continuous renal replacement therapy (CRRT) is the dominant form of RRT for AKI in Australia. [11] In the most recent survey of 130 practitioners from 27 sites in the United States, IHD and CRRT were used in 57 and 36% of patients with AKI needing dialysis, respectively.…”

Section: F Afshinnia Et Almentioning

confidence: 99%

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Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Afshinnia

Straight

Li³

et al. 2009

Renal Failure

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Backgrounds. There are no national level data on types of dialysis in use for acute kidney injury (AKI). We aimed to assess trends in dialysis modality for AKI and mortality associated with each modality from 1998 to 2005. Methods. Using data from the 5% Medicare cohort, we identified individuals with AKI requiring dialysis. Individuals with preexisting end-stage renal disease were excluded. Intermittent hemodialysis (IHD), daily intermittent hemodialysis, and continuous renal replacement therapy (CRRT) were defined using Current Procedure Terminology codes. Mortality was defined as death during 30 days after the first dialysis session. Results. Between 1998 and 2005, there were a total of 18,249 patients identified with AKI requiring renal replacement therapy. CRRT was increasingly used for AKI, with 9.9% of patients in 1998 to 18.3% by 2005. Proportion of daily dialysis decreased during this period, while use of IHD remained stable at approximately 68%. Overall 30-day mortality declined from 44.4% in 1998 to 40.2% in 2005.Crude mortality for CRRT was highest in all years (51.0-61.8%), followed by daily (38.2-49.9%) and IHD groups (35.8-43.4%). Multinomial logistic regression analysis showed that white race, presence of sepsis, atherosclerotic heart diseases, peripheral vascular diseases, dysrhythmia, gastrointestinal and liver diseases, and any year after 2000 were independently associated with higher odds of using CRRT after adjusting for other variables. Conclusion. The proportion of patients using CRRT has increased over time. Mortality associated with IHD has decreased from 1998 to 2005. Mortality associated with different dialysis modalities is likely the result of severity of illness.

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Section: Discussionmentioning

confidence: 85%

Section: F Afshinnia Et Almentioning

confidence: 99%

Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Afshinnia

Straight

Li³

et al. 2009

Renal Failure

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“…Fourthly, our heparin algorithm only includes a maximum APTTr value but not a target value [7]. The aim of this strategy is to achieve circuit patency without unnecessary or excessive patient anticoagulation and is in line with expert opinion and current practice in the UK [23,24]. However, we cannot exclude that circuits anticoagulated with heparin would have lasted longer if the dose of heparin had been increased.…”

Section: Discussionmentioning

confidence: 99%

Beyond the Randomized Clinical Trial: Citrate for Continuous Renal Replacement Therapy in Clinical Practice

Tovey¹,

Dickie²,

Gangi³

et al. 2013

Nephron Clin Pract

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Background: Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. Methods: We retrospectively analysed data on circuit patency of all circuits used in a single centre between September 2008 and August 2009. We differentiated between premature filter clotting, elective discontinuation and waste. Results: 309 patients were treated with CRRT (n = 2,059 circuits). The mean age was 65.7; 63.8% were male. The methods to maintain circuit patency were unfractionated heparin (42.3%), epoprostenol (23.0%), citrate (14.7%), combinations of different anticoagulants (14.6%) and no anticoagulation (4.7%). Premature clotting was the most common reason for circuit discontinuation among circuits anticoagulated with heparin, epoprostenol or combinations of different anticoagulants (59-62%). Among circuits anticoagulated with citrate the main reason for discontinuation was elective (61%). Hazard regression analysis confirmed significantly better circuit survival with citrate. Changing from heparin to citrate decreased the risk of premature circuit clotting by 75.8%. Conclusion: In routine clinical practice, regional anticoagulation withcitrate is associated with significantly better circuit patency than heparin or epoprostenol.

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“…51 In an international sampling of ICUs, the most frequently employed continuous modality was CVVH, 52 as was also true for patients in the United Kingdom. 53 In surveys of specific countries and regions, peritoneal dialysis remains the predominant therapy due to its relative ease and lower cost as compared to IHD. [54][55][56] Peritoneal dialysis is preferred in the pediatric population after surgery for repair of congenital cardiac disease 57,58 and possibly for adult cardiac transplant patients.…”

Section: O N O T D I S T R I B U T Ementioning

confidence: 99%