Renal replacement therapy in intensive care units: a survey of nephrological practice in northwest Italy

Background: Few reports have addressed how current practice reflects uncertainty as to the optimal management of renal replacement therapy (RRT) in Western countries. Current dialytic practice for 2007 in the northwest of Italy was assessed. Methods: A total of 24 nephrology and dialysis centers covering all of the RRT provided in the intensive care units (ICUs) in northwest Italy took part in the survey. Consultant nephrologists of each center reported their own activities throughout the year 2007 by an e-mailed questionnaire. Results: RRT for a total of 7,842 days was provided by 24 dialysis centers in 79 ICUs for 1,118 patients. RRT median duration (5.76 days/patient) increased with the increasing number of hospital ICU beds. Of the RRT cases, 69.9% were due to acute kidney injury, 23.6% for continuation of a treatment in chronic dialysis patients and 4.2% for extrarenal indications. 1 Nephrology and Dialysis Unit, CTO Hospital, Turin Italy 2 Nephrology and Dialysis Unit, Giovanni Bosco Hospital, Turin Italy 3 Nephrology and Dialysis Unit, Santa Croce e Carle Hospital, Cuneo Italy 4 Nephrology and Dialysis Unit, Mauriziano Hospital, Turin Italy 5 Nephrology, Dialysis and Transplantation Unit, Molinettte Hospital and Nephrology and Dialysis Unit, Civile Hospital, Chivasso, Turin Italy 6 Nephrology and Dialysis Unit, S.S. Antonio e Biagio Hospital, Alessandria Italy 7 Nephrology, Dialysis and Transplantation Unit, OIRM Hospital, Turin Italy 8 Nephrology and Dialysis Unit, Umberto Parini Hospital, Aosta Italy 9 Nephrology and Dialysis Unit, Maggiore Hospital, Novara Italy Filippo Mariano 1, Marco Pozzato 2, Giorgio Canepari 3, Corrado Vitale 4, Francesca Bermond 5, Colombano Sacco 6, Alessandro Amore 7, Massimo Manes 8, Carlo Navino 9 ; Piedmont and Aosta Valley Section of Italian Society of Nephrology Collaborators: Andrea Campo (Alba, CN), Dario Sassone (Asti), Gianmario Bosticardo (Biella), Paola Carpani (Borgomanero, NO), Giovanni Calabrese (Casale Monferrato, AL), Marco Formica (Ceva, CN), Emanuele Stramignoni (Chieri, TO), Alfonso Pacitti (Chivasso, TO), Andrea Serra (Cirie’, TO), Franco Bonello (Ivrea, TO), Antonio Marciello (Pinerolo, TO), Vincenzo Todini (Rivoli, TO), Carmelina di Tullio (Torino), Cesare Guarena (Torino), Maurizio Borzumati (Verbania), Gianenrico Guida (Vercelli) Renal replacement therapy in intensive care units: a survey of nephrological practice in northwest Italy ORIGINAL ARTICLE More than 90% of the patients were treated with high permeability membranes, at a median target dosage of 35.0 ml/kg per hour in continuous (39.4%) or extended modality (6-14 hours, 38.5%). Unfractionated heparin was the most common anticoagulant used (67.5%, median 500 IU/hour). In patients at high risk of bleeding, RRT without or with heparin at low-dose + saline flushes was the most commonly adopted line of treatment, followed by citrate (18% of days of dialysis). The decision to start RRT was made by nephrologists alone or in collaboration with intensivists, whereas dose prescriptions were given by nephrologists alone. Conclusions: This survey may represent a useful starting point for further research into changes in RRT practice and the adoption of common, shared protocols.