Continuous renal replacement therapy: current practice in Australian and New Zealand intensive care units

Abstract

Background: The publication of large multicentre studies devoted to Continuous Renal Replacement Therapies (CRRT) in critically ill patients may influence the bedside prescription and practical application of the treatment. Despite this, many aspects of this therapy may not be informed by evidence, but remain a product of clinician preference. Little is known about the current CRRT practice in Australian and New Zealand (ANZ) ICUs and it is not known if the evidence from recent studies has been integrated into practice.

Design and Setting: A prospective on-line survey of CRRT practice was sent to ICU clinicians (medical and nursing) via three different national databases in ANZ ICUs during December 2013 to March 2014.

Results: There were 194 respondents from 106 ICUs: 49 ICUs (47%) were in tertiary metropolitan hospitals. One hundred and two respondents (52%) reported CVVHDF as the most common CRRT technique with the combination of pre and post-dilution of replacement solutions. There is variability in the prescription of dosing for CRRT with respondents indicating the therapy based on litres per hour (53%) or a weight adjusted treatment in mls/kg/hr (47%).

For all modes of CRRT, the common blood flow rates applied were 100-150 and 150-200 ml/min; with few respondents reporting flow rates < 150 or > 300 ml/min. Unfractionated heparin was the most common (83%) anticoagulant followed by regional citrate. Femoral vascular access was preferred and typically a 20cm length device inserted with Bard Niagara® and Arrow® access catheters most frequently used. The Baxter/Gambro Prismaflex was the dominant machine platform with 71% of respondents indicating its use in their ICUs.

Conclusions: These results provide insight into existing clinical management of CRRT. Considerable variation still exists in the practical prescription of CRRT in ANZ ICUs.