Renal replacement therapy for acute renal failure: a survey of practice in adult intensive care units in the United Kingdom

Abstract

This study surveyed current practice in adult intensive care units in the United Kingdom in three key areas of renal replacement therapy when used for acute renal failure: type of therapy used, typical treatment dose and anticoagulation. Responses were received from 303 (99%) of the 306 intensive care units. 269 units (89%) provide renal replacement therapy for acute renal failure. Most (65%) use continuous veno-venous haemofiltration as first-line therapy in the majority of patients, though continuous veno-venous haemodiafiltration is used by 31% of units. For haemofiltration, the median typical treatment dose (interquartile range [range]) is 32 ml.kg(-1).h(-1) (28.6-35.7 [14.3-85.7]), with 49% using a treatment dose of 35 ml.kg(-1).h(-1) or greater. For haemodiafiltration, the median typical treatment dose (interquartile range [range]) is 44 ml.kg(-1).h(-1) (28.6-57.1 [21.4-120.7]), with 67% using a treatment dose of 35 ml.kg(-1).h(-1) or greater. The vast majority of intensive care units use intravenous unfractionated heparin (96%) or epoprostenol (88%) for anticoagulation. Dosage and monitoring of these two agents vary markedly between units. No units use citrate anticoagulation. These results reveal a wide variety of practice in the delivery of renal replacement therapy between intensive care units in the United Kingdom.