PMID- 17594074
OWN - NLM
STAT- MEDLINE
DCOM- 20080226
LR  - 20220408
IS  - 0342-4642 (Print)
IS  - 0342-4642 (Linking)
VI  - 33
IP  - 9
DP  - 2007 Sep
TI  - Continuous renal replacement therapy: a worldwide practice survey. The beginning 
      and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators.
PG  - 1563-70
AB  - OBJECTIVE: Little information is available regarding current practice in 
      continuous renal replacement therapy (CRRT) for the treatment of acute renal 
      failure (ARF) and the possible clinical effect of practice variation. DESIGN: 
      Prospective observational study. SETTING: A total of 54 intensive care units 
      (ICUs) in 23 countries. PATIENTS AND PARTICIPANTS: A cohort of 1006 ICU patients 
      treated with CRRT for ARF. INTERVENTIONS: Collection of demographic, clinical and 
      outcome data. MEASUREMENTS AND RESULTS: All patients except one were treated with 
      venovenous circuits, most commonly as venovenous hemofiltration (52.8%). 
      Approximately one-third received CRRT without anticoagulation (33.1%). Among 
      patients who received anticoagulation, unfractionated heparin (UFH) was the most 
      common choice (42.9%), followed by sodium citrate (9.9%), nafamostat mesilate 
      (6.1%), and low-molecular-weight heparin (LMWH; 4.4%). Hypotension related to 
      CRRT occurred in 19% of patients and arrhythmias in 4.3%. Bleeding complications 
      occurred in 3.3% of patients. Treatment with LMWH was associated with a higher 
      incidence of bleeding complications (11.4%) compared to UFH (2.3%, p = 0.0083) 
      and citrate (2.0%, p = 0.029). The median dose of CRRT was 20.4 ml/kg/h. Only 
      11.7% of patients received a dose of > 35 ml/kg/h. Most (85.5%) survivors 
      recovered to dialysis independence at hospital discharge. Hospital mortality was 
      63.8%. Multivariable analysis showed that no CRRT-related variables (mode, filter 
      material, drug for anticoagulation, and prescribed dose) predicted hospital 
      mortality. CONCLUSIONS: This study supports the notion that, worldwide, CRRT 
      practice is quite variable and not aligned with best evidence.
FAU - Uchino, Shigehiko
AU  - Uchino S
AD  - Jikei University School of Medicine, Intensive Care Unit, Department of 
      Anesthesiology, Tokyo, Japan.
FAU - Bellomo, Rinaldo
AU  - Bellomo R
FAU - Morimatsu, Hiroshi
AU  - Morimatsu H
FAU - Morgera, Stanislao
AU  - Morgera S
FAU - Schetz, Miet
AU  - Schetz M
FAU - Tan, Ian
AU  - Tan I
FAU - Bouman, Catherine
AU  - Bouman C
FAU - Macedo, Ettiene
AU  - Macedo E
FAU - Gibney, Noel
AU  - Gibney N
FAU - Tolwani, Ashita
AU  - Tolwani A
FAU - Oudemans-van Straaten, Heleen
AU  - Oudemans-van Straaten H
FAU - Ronco, Claudio
AU  - Ronco C
FAU - Kellum, John A
AU  - Kellum JA
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20070627
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
RN  - 0 (Anticoagulants)
RN  - 0 (Benzamidines)
RN  - 0 (Citrates)
RN  - 0 (Guanidines)
RN  - 1Q73Q2JULR (Sodium Citrate)
RN  - 9005-49-6 (Heparin)
RN  - Y25LQ0H97D (nafamostat)
SB  - IM
CIN - Intensive Care Med. 2007 Sep;33(9):1503-5. PMID: 17594073
MH  - Acute Kidney Injury/epidemiology/*therapy
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Arrhythmias, Cardiac/epidemiology
MH  - Benzamidines
MH  - Citrates/therapeutic use
MH  - Drug Utilization/*statistics & numerical data
MH  - Female
MH  - Guanidines/therapeutic use
MH  - Hemorrhage/epidemiology
MH  - Heparin/therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - Hypotension/epidemiology
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Prospective Studies
MH  - Recovery of Function
MH  - Renal Replacement Therapy/adverse effects/methods/*statistics & numerical data
MH  - Sodium Citrate
EDAT- 2007/06/28 09:00
MHDA- 2008/02/27 09:00
CRDT- 2007/06/28 09:00
PHST- 2006/11/23 00:00 [received]
PHST- 2007/05/29 00:00 [accepted]
PHST- 2007/06/28 09:00 [pubmed]
PHST- 2008/02/27 09:00 [medline]
PHST- 2007/06/28 09:00 [entrez]
AID - 10.1007/s00134-007-0754-4 [doi]
PST - ppublish
SO  - Intensive Care Med. 2007 Sep;33(9):1563-70. doi: 10.1007/s00134-007-0754-4. Epub 
      2007 Jun 27.