How and when do we use continuous renal replacement therapy for acute kidney injury in Serbia? - The multicentric survey

Abstract

Background / Aim. Absence of clear guidance in the definition, diagnostics and indications for renal replacement treatment (RRT) is present. The aim of this survey is creating a unique strategy for diagnostics and treatment of acute kidney injury (AKI) based on the current clinical practice. Methods. ? Results. We have conducted a multicentric web-survey among nephrologists (46.8%) and other physicians in Serbia. The sample consisted of 119 participants, 78.9% out of which filled out the survey forms correctly, and were, therefore, included in the analysis. Most of them responded that the nephrologist indicates (76.8%) and prescribes (74.5%) of continuous renal replacement therapy (CRRT).The application of KDIGO 2 criterion for ?early? start of CRRT used 74.5% of the respondents, and 91.5% of them started ?late? initiation of CRRT in the presence of complications associated with AKI or poor response to conservative treatment. Regarding clinical experience of the respondents, 74.5% of them marked ?early? start of CRRT within 12 hours whereas 56.4% of them considered the start of CRRT after 48h as ?late?. The most commonly used modality was continuous venous hemodiafiltration (37.6%). Most participants used heparin as anticoagulant (95.7%) with average life span of filters less than 24 hours (71.3%) and 25 ml/kg/h efficiency target dialysis effluent dose (45.2%) during CRRT. The most common complications of CRRT were hypotension (55.3%) and catheter-related infections (29.8%). Conclusion. ?Early? start of CRRT is considered favorite by the majority of the participants. According to the obtained data, standardization of the strategy in the diagnostics and treatment of AKI is necessary.