Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2026 Jan;52(1):1-10.
doi: 10.1007/s00134-025-08213-4. Epub 2025 Nov 25.

Trends in renal replacement therapy use in intensive care unit: insights from a French multicenter cohort

Julien Schmidt  1 , Lamiae Grimaldi  2 , Patricia Martel  2 , Céline Piedvache  2 , Bertrand Guidet  3 , Khalil Chaïbi  1   4 , Didier Dreyfuss #  4   5 , Stéphane Gaudry #  6   7   8
Affiliations
Multicenter Study

Trends in renal replacement therapy use in intensive care unit: insights from a French multicenter cohort

Julien Schmidt et al. Intensive Care Med. 2026 Jan.

Abstract

Introduction: Renal replacement therapy (RRT) during acute kidney injury (AKI) in critically ill patients used to be started early for long. Recent trials supporting a conservative approach with delayed RRT initiation may have influenced clinical practice. We aim to assess temporal trends in the use of RRT among intensive care unit (ICU) patients with AKI over a 12-year period.

Materials and methods: We conducted a retrospective cohort study using data from the CUB-Réa database, including ICU patients with AKI who required invasive mechanical ventilation and/or catecholamine infusion between 2008 and 2019. Patients were grouped into three periods based on the calendar year of ICU stay: 2008-2011, 2012-2015, and 2016-2019. The primary outcome was the temporal trend in RRT utilization. Secondary outcomes included annual crude RRT rates per 1000 ICU stays and trends in RRT modality. Multivariable logistic regression was used to adjust for confounders. We used a monthly interrupted time series (ITS) over 2008-2019 with a prespecified breakpoint at July 2016 (AKIKI trial publication).

Results: Among 45,242 eligible ICU stays, 16,999 (37.6%) required RRT. The use of RRT decreased over the study period, from 39.7% in 2008-2011 to 37.4% in 2012-2015, and to 35.9% in 2016-2019 (p < 0.0001). Adjusted analyses confirmed this trend, with an odds ratio (OR) of 0.91 (95% CI 0.87-0.96) for 2012-2015 and 0.80 (95% CI 0.76-0.84) for 2016-2019, compared to the baseline period. In the adjusted ITS analysis, only the post-intervention monthly trend reached statistical significance (RR per year = 0.97; 95% CI 0.94-0.99). The annual crude rate of RRT use declined from 441 per 1000 ICU stays at baseline to 339 in 2019 (relative reduction: 20.8%). Use of intermittent RRT declined, while continuous modestly increased.

Conclusions: Among critically ill patients with AKI, RRT use decreased in the past decade. This suggests a progressive shift toward more conservative RRT initiation strategies.

Keywords: Acute kidney injury; Epidemiology; Renal replacement therapy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflicts of interest: The authors declare no competing interest regarding the submitted work. Ethical approval: The present study was approved by the medical ethics committee of Avicenne University Hospital (CLEA-2025-467).

References

    1. Hoste EAJ, Bagshaw SM, Bellomo R et al (2015) Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 41:1411–1423. https://doi.org/10.1007/s00134-015-3934-7 - DOI - PubMed
    1. Ronco C, Bellomo R, Kellum JA (2019) Acute kidney injury. Lancet Lond Engl 394:1949–1964. https://doi.org/10.1016/S0140-6736(19)32563-2 - DOI
    1. Brochard L, Abroug F, Brenner M et al (2010) An official ATS/ERS/ESICM/SCCM/SRLF statement: prevention and management of acute renal failure in the ICU patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med 181:1128–1155. https://doi.org/10.1164/rccm.200711-1664ST - DOI - PubMed
    1. Montford JR, Linas S (2017) How dangerous is hyperkalemia? J Am Soc Nephrol JASN 28:3155–3165. https://doi.org/10.1681/ASN.2016121344 - DOI - PubMed
    1. Smith I, Kumar P, Molloy S et al (2001) Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 27:74–83. https://doi.org/10.1007/s001340051352 - DOI - PubMed

Publication types

LinkOut - more resources