Abstract
IntroductionThe current prescription and practice of net ultrafiltration among critically ill patients receiving kidney replacement therapy in the U.S. are unclear.Aim of the studyTo assess the attitudes of U.S. critical care practitioners on net ultrafiltration (UFNET) prescription and practice among critically ill patients with acute kidney injury treated with kidney replacement therapy.MethodsA secondary analysis was conducted of a multinational survey of intensivists, nephrologists, advanced practice providers, and ICU and dialysis nurses practising in the U.S.ResultsOf 1,569 respondents, 465 (29.6%) practitioners were from the U.S. Mainly were nurses and advanced practice providers (58%) and intensivists (38.2%). The median duration of practice was 8.7 (IQR, 4.2-19.4) years. Practitioners reported using continuous kidney replacement therapy (as the first modality in 60% (IQR 20%-90%) for UFNET. It was found that there was a significant variation in assessment of prescribed-to-delivered dose of UFNET, use of continuous kidney replacement therapy for UFNET, methods used to achieve UFNET, and assessment of net fluid balance during continuous kidney replacement therapy. There was also variation in interventions performed for managing hemodynamic instability, perceived barriers to UFNET, belief that early and protocol-based fluid removal is beneficial, and willingness to enroll patients in a clinical trial.ConclusionsThere was considerable practice variation in UFNET among critical care practitioners in the U.S., reflecting the need to generate evidence-based practice guidelines for UFNET.
Highlights
The current prescription and practice of net ultrafiltration among critically ill patients receiving kidney replacement therapy in the U.S are unclear
Of the U.S practitioners, 177 (38.2%) respondents were self-identified as intensivists, 11 (2.4%) as nephrologists, 8 (1.7%) as nephrologists and intensivists, 239 (51.6%) as intensive care unit (ICU) nurses caring for patients receiving kidney replacement therapy, and 30 (6%) as advanced practice providers
Most practitioners were ICU nurses, had an average of 8.7 years of experience, and were from university-based hospitals. This survey predominantly reflects nurses attitudes towards the practice of UFNET, variations were noted in the assessment of prescribed-to-delivered dose of UFNET, the use of continuous kidney replacement therapy for UFNET, the methods used to achieve UFNET, and assessment of net fluid balance during Continuous Kidney Replacement Therapy (CKRT)
Summary
The current prescription and practice of net ultrafiltration among critically ill patients receiving kidney replacement therapy in the U.S are unclear. Net ultrafiltration (UFNET), known as net fluid removal during kidney replacement therapy, is frequently used by clinicians to treat fluid overload for more than seven decades and is currently recommended by several international clinical practice guidelines [4,5,6]. This recommendation is based on several observational studies suggesting that fluid removal is associated with a lower risk of death [1, 7, 8]. Data on net ultrafiltration practice patterns in the intensive care unit (ICU) and clinician perspectives on fluid removal are scarce
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