To assess the attitudes of practitioners with respect to net ultrafiltration prescription
and practice among critically ill patients with acute kidney injury treated with renal replacement therapy
Multinational internet-assisted survey
Critical care practitioners involved with 14 societies in 80 countries.
Intensivists, nephrologists, advanced practice providers, ICU and dialysis nurses.
A cross-sectional survey
Measurement and Main Results:
Of 2,567 practitioners who initiated the survey
, 1,569 (61.1%) completed the survey
. Most practitioners were intensivists (72.7%) with a median duration of 13.2 years of practice (interquartile range, 7.2–22.0 yr). Two third of practitioners (71.0%; regional range, 55.0–95.5%) reported using continuous renal replacement therapy
with a net ultrafiltration
of median 80.0 mL/hr (interquartile range, 49.0–111.0 mL/hr) for hemodynamically unstable and a maximal rate of 299.0 mL/hr (interquartile range, 200.0–365.0 mL/hr) for hemodynamically stable patients, with regional variation. Only a third of practitioners (31.5%; range, 13.7–47.8%) assessed hourly net fluid balance during continuous renal replacement therapy
. Hemodynamic instability was reported in 20% (range, 20–38%) of patients and practitioners decreased the rate of fluid removal (70.3%); started or increased the dose of a vasopressor (51.5%); completely stopped fluid removal (35.8%); and administered a fluid bolus (31.6%), with significant regional variation. Compared with physicians, nurses were most likely to report patient intolerance to net ultrafiltration
(73.4% vs 81.3%; p
= 0.002), frequent interruptions (40.4% vs 54.5%; p
< 0.001), and unavailability of trained staff (11.9% vs 15.6%; p
= 0.04), whereas physicians reported unavailability of dialysis machines (14.3% vs 6.1%; p
< 0.001) and costs associated with treatment as barriers (12.1% vs 3.0%; p
< 0.001) with significant regional variation.
Our study provides new knowledge about the presence and extent of international practice variation in net ultrafiltration
. We also identified barriers and specific targets for quality improvement initiatives. Our data reflect the need for evidence-based practice guidelines for net ultrafiltration