Management of renal replacement therapy in ICU patients: an international survey

Purpose: The optimal management of renal replacement therapy (RRT) in critically ill patients remains a matter of debate, although insights have arisen from recent large trials. Nonetheless, little is known about the current practices and beliefs of intensivists. The goal of this study was to record current practices in RRT management among an international panel of intensivists. Methods: An online questionnaire that included questions about RRT management in critically ill patients with acute kidney injury was sent to European Society of Intensive Care Medicine members in 2010. Results: Two hundred and seventy-three intensivists from 50 countries responded. The respondents had an average of 12 (7-20) years of experience in ICUs, and most of them worked in mixed ICUs. Most of the intensivists were responsible for prescribing RRT (92.6 %). Half of the respondents reported using both intermittent haemodialysis and continuous renal replacement therapy techniques (CRRT), but most preferred using CRRT. The reasons for preferring CRRT were the perception of better haemodynamic stability, better therapeutic effect resulting from cytokine removal and easier fluid balance control. The intensivists used higher RRT doses in septic patients than in non-septic patients (p = 0.03). Finally, we observed an increasing inclination towards the early use of RRT among the intensivists. Conclusion: CRRT remains the preferred technique for most intensivists in Europe, and a large proportion of the participating intensivists used RRT prescription doses similar to those proposed a decade ago. Our results provide insights into the motivations of intensivists while presenting the technique that may help in selecting control groups for future trials.