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Management of Renal Replacement Therapy in Acute Kidney Injury: A Survey of Practitioner Prescribing Practices

Pamela Overberger^*, Matthew Pesacreta, Paul M. Palevsky^*,; for the VA/NIH Acute Renal Failure Trial Network

^* Research Service and Renal Section, Medical Specialty Service Line, VA Pittsburgh Healthcare System, and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Address correspondence to: Dr. Paul M. Palevsky, Room 7E123 (111F-U), VA Pittsburgh Healthcare System, University Drive Division, Pittsburgh, PA 15240-0001. Phone: 412-688-6474; Fax: 412-688-6908; E-mail: palevsky{at}pitt.edu

Background: Data on current practices for management of renal replacement therapy (RRT) in acute kidney injury (AKI) are limited, particularly with regard to the dosing of therapy.

Design, setting, participants, and measurements: A survey was conducted of practitioners at the 27 study sites that participate in the Veterans Affairs/National Institutes of Health Acute Renal Trial Network (ATN) Study before initiation of patient enrollment for ascertainment of the local prevailing practices for management of RRT in critically ill patients with AKI. Surveys were returned from 130 practitioners at 26 of 27 study sites; the remaining study site provided aggregate data.

Results: Intermittent hemodialysis and continuous RRT were the most commonly used modalities of RRT, with sustained low-efficiency dialysis and other "hybrid" treatments used in fewer than 10% of patients. Intermittent hemodialysis was most commonly provided on a thrice-weekly or every-other-day schedule, with only infrequent assessment of the delivered dosage of therapy. Most practitioners reported that they did not dose continuous RRT on the basis of patient weight. The average prescribed dosage of therapy corresponded to a weight-based dosage of no more than 20 to 25 ml/kg per h.

Conclusions: These results provide insight into clinical management of RRT and provide normative data for evaluation of the design of ongoing clinical trials.

This article has been cited by other articles:

				The VA/NIH Acute Renal Failure Trial Network Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury N. Engl. J. Med., July 3, 2008; 359(1): 7 - 20. [Abstract] [Full Text] [PDF]