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. 2023 Jan 13;3(2):147-154.
doi: 10.1016/j.jointm.2022.10.005. eCollection 2023 Apr 30.

Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

Florian Jolly  1 , Marine Jacquier  1   2 , Delphine Pecqueur  3   4 , Marie Labruyère  1   3   4 , Christophe Vinsonneau  5 , Isabelle Fournel  3   4 , Jean-Pierre Quenot  1   2   3   4 ; READIAL Study group
Collaborators, Affiliations

Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

Florian Jolly et al. J Intensive Med. .

Abstract

Background: This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).

Methods: From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.

Results: A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.

Conclusions: Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Keywords: Acute kidney injury; Bedside; Intensive care unit; Practice evaluation; Renal replacement therapy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Main indications for initiating renal replacement therapy.
Figure 2
Figure 2
Insertion sites of the first hemodialysis catheter for initiation of renal replacement therapy.
Figure 3
Figure 3
Factors explaining the insertion of the hemodialysis catheter via an approach other than the right internal jugular. ARDS: Acute respiratory distress syndrome.
Figure 4
Figure 4
Characteristics of the catheters used for renal replacement therapy.
See this image and copyright information in PMC

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