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. 2025 Aug:88:155076.
doi: 10.1016/j.jcrc.2025.155076. Epub 2025 Apr 3.

Renal replacement therapy modalities and techniques in intensive care units: An international survey

Céline Monard  1 , Arnaud Marel  2 , Michael Joannidis  3 , Marlies Ostermann  4 , Zhiyong Peng  5 , Kent Doi  6 , Silvia De Rosa  7 , Ilona Bobek  8 , Dmitry Sokolov  9 , Vin-Cent Wu  10 , Vedran Premuzic  11 , Ravindra Mehta  12 , Rinaldo Bellomo  13 , Xaime Garcia  14 , Camilo Pizarro  15 , Alexander Zarbock  16 , Igor Milet  17 , Thiago Reis  18 , Marc Romain  19 , Bairbre Mc Nicholas  20 , Antoine Schneider  21 , Thomas Rimmelé  22 ; ESICM AKI section
Affiliations
Free article

Renal replacement therapy modalities and techniques in intensive care units: An international survey

Céline Monard et al. J Crit Care. 2025 Aug.
Free article

Abstract

Background and hypothesis: Up to 14 % of critically ill patients receive renal replacement therapy (RRT) during their ICU stay and are treated with intermittent hemodialysis (IHD) or one of the continuous renal replacement therapy (CRRT) techniques. The choice of a modality (IHD or CRRT) and technique (continuuous veno-venous -hemodialysis (CVVHD), -hemofiltration (CVVH), or - hemodiafiltration (CVVHDF)), and the way it is delivered, may have an impact on outcomes but only few studies addressed this question. We aimed to survey the availability, settings, and clinicians' preferences regarding RRT modalities and techniques in critically ill patients.

Methods: Between July 2021 and March 2022, we conducted an open online worldwide survey targeting ICU clinicians and consisting of 31 questions.

Results: Among the 1174 participants from 73 countries, 94 % indicated their ability to initiate RRT at any time. CRRT was more widely available than IHD (97 % vs 85 %). CVVHDF was the most frequently used CRRT technique (59 %), followed by CVVHD (26 %) and CVVH (16 %). Most participants (70 %) reported having access to at least two CRRT techniques in their unit. Preference for IHD or CRRT varied greatly, depending on the clinical situation. Among CRRT techniques, CVVHD was preferred for removal of small-sized molecules, better hemofilter lifespan and reduced nursing workload. The preferential indications for CVVH included septic shock, removal of middle-sized molecules and fluid overload. The technical settings for CVVH and CVVHDF were very heterogeneous.

Conclusion: This international survey underscores the large diversity in RRT practices wordlwide, as well as heterogeneity in beliefs and preferences among intensivists. These data highlight the need for robust comparative trials to identify the optimal RRT modality and technique to improve outcomes in specific clinical situations.

Keywords: Continuous renal replacement therapy; Intensive care unit; Intermittent hemodialysis; Organization of care; Practices; Renal replacement therapy; Survey.

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Conflict of interest statement

Declaration of competing interest CM received speaker honoraria from Baxter, Fresenius Medical Care and bioMerieux. AM does not report any conflicts of interest. MJ has received honoraria or research support from Baxter Healthcare Corp, AM-Pharma, CLS Behring, Fresenius, Takeda and Novartis outside the submitted work. MO's institution received research support from Baxter and BioMerieux. ZP does not report any conflicts of interest. KD received lecture and consultancy fees from Toray, Nipro, and AM Pharma. SDR received speaker honoraria from Baxter, Fresenius Medical Care, Biotest, Estor, Jafron, Toray. DS received speaker honoraria from Baxter, Fresenius Medical Care, Bbraun and Efferon. VCW does not report any conflicts of interest. VP received speaker honoraria from Baxter, Fresenius Medical Care, Cytosorbents and Astellas. RM has received consulting fees from Am Pharma, Baxter, Fresenius, Sphingotec, Alexion, Mallinckrodt, Rensym, Abiomed, SeaStar, Biomerieux, and served on Data Safety and Advisory Boards for Novartis, Guard therapeutics and Unicycive. RB has received consulting fees from Baxter and Jafron and speker honoraria from Jafron, Baxter, Viatris. XG does not report any conflicts of interest. CP does not report any conflicts of interest. AZ has received consulting fees from Astute-Biomerieux, Baxter, Bayer, Novartis, Guard Therapeutics, AM Pharma, Paion, Fresenius, research funding from Astute-Biomerieux, Fresenius, Baxter, and speakers fees from Astute-Biomerieux, Fresenius, Baxter. IM does not report any conflicts of interest. TReis received grants from JAfron, consulting fees from Baxter, Medcorp, Contatti, Euroframa, Lifepharma, George Clinical ans speaker honoraria from AstraZeneca, BBraun, Baxter, bioMerieux, Boehringer Ingelheim, Contatti Medical, Euroframa, Jafron, Lifepharma, Medcorp, Nova biomedical, Nipro, Alexion. MR received speaker honoraria from Baxter. BMcNs' institution received consulting fees from Teleflex and she is Deputy Chair of the Irish Critical Trials research Group. AS received speaking honorarium from Fresenius Medical Care, CytoSorbents Corporation and Jafron as well as unrestricted funding from B Braun and Jafron. TR received speaker honoraria from Baxter, Fresenius Medical Care, Bbraun, BioMerieux, Estor, Jafron, Exthera, Infomed and Nikkiso.

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