Renal replacement therapy in Scottish critical care units: A national audit of practices

Abstract

Large randomised controlled trials show no benefit of high intensity renal replacement therapy compared to lower intensity regimens. Previous data suggest large variation in practice. This audit evaluated practices in relation to intensity of replacement therapy in critical care units across the Scottish National Health Service over a 28-day period. The mean delivered weight-adjusted effluent flow rates for continuous veno-venous haemofiltration were 29.1 (8.1 SD) ml kg À1 h À1which was 89% of that prescribed. For continuous veno-venous haemodiafiltration, the mean delivered dose was 41.3 (7.9) ml kg À1 h À1 which was 88.4% of that prescribed. Of the eight patients undergoing intermittent haemodialysis, seven had daily treatments, whilst the eighth had four treatments in five days. The prescription and delivery of renal replacement therapy within Scottish critical care units are routinely performed at an intensity that is higher than necessary. Avoidance of excessive dose could provide important cost savings.

Acute intermittent renal replacement therapy in a rural Scottish intensive care unit – a review of patient and renal outcomes

“…3 A 2012 audit of Scottish ICUs revealed the majority of units within Scotland (15 of 18) favoured continuous RRT strategies. 8 This may be due to a perception that continuous therapies offer haemodynamic or renal survival advantage over intermittent therapies. However, a 2002 meta-analysis found no evidence to support this, 9 a finding confirmed in a large multicentre observational study and supported by international guidelines.…”