Background: The practice of renal replacement therapy (RRT) has reached an optimal standard of care worldwide. Nevertheless, some aspects of acute renal failure treatment and support still present wide variability between different centers. This is especially true for the mode and dose of RRT. This review describes the epidemiology of dialysis prescription and delivery around the world based on recent observational studies and international surveys. Results: Continuous RRT is delivered in 80% of intensive care units around the world. Since a certain consensus has been achieved on the adequacy of 35 ml/kg/h of clearance in continuous therapies, recent observations based on questionnaires and surveys demonstrated that such adequate therapy was only prescribed in the minority of patients. The number of centers prescribing adequate dialysis dose is increasing, but there are still many institutions where prescription is made with no specific adequacy targets and effective delivery is not measured. Several barriers to reaching adequacy targets have been identified including the lack of a high evidence multicentric trial, logistics, costs, personnel and technical difficulties. Conclusion: A trend to continuous therapies and increased RRT dosage over the last 10 years is shown by the surveys presented, even if scientific evidence is now very necessary as far as definitive RRT indications and prescriptions are concerned. Copyright (C) 2007 S. Karger AG, Basel.
Results from international questionnaires
Ronco C
2007
Abstract
Background: The practice of renal replacement therapy (RRT) has reached an optimal standard of care worldwide. Nevertheless, some aspects of acute renal failure treatment and support still present wide variability between different centers. This is especially true for the mode and dose of RRT. This review describes the epidemiology of dialysis prescription and delivery around the world based on recent observational studies and international surveys. Results: Continuous RRT is delivered in 80% of intensive care units around the world. Since a certain consensus has been achieved on the adequacy of 35 ml/kg/h of clearance in continuous therapies, recent observations based on questionnaires and surveys demonstrated that such adequate therapy was only prescribed in the minority of patients. The number of centers prescribing adequate dialysis dose is increasing, but there are still many institutions where prescription is made with no specific adequacy targets and effective delivery is not measured. Several barriers to reaching adequacy targets have been identified including the lack of a high evidence multicentric trial, logistics, costs, personnel and technical difficulties. Conclusion: A trend to continuous therapies and increased RRT dosage over the last 10 years is shown by the surveys presented, even if scientific evidence is now very necessary as far as definitive RRT indications and prescriptions are concerned. Copyright (C) 2007 S. Karger AG, Basel.
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