How and when do we use continuous renal replacement therapy for acute kidney injury in Serbia? - The multicentric survey

Abstract

Background/Aim. The absence of clear guidance in the definition, diagnostics, and indications for renal replacement treatment (RRT) is present. The aim of this study was to help outlining future clinical work in improving the treat-ment outcome and reducing complications of acute kidney injury (AKI) based on the current clinical practice. Meth-ods. The questionnaires were distributed among physicians of different specialties who participated voluntarily and anonymously. The questionnaire was drawn up in accord-ance with the standard clinical practice. Results. We con-ducted a multicentric web survey among nephrologists (46.8%) and other physicians in Serbia. The sample consist-ed of 119 participants, out of which 78.9% filled out the survey forms correctly and were, therefore, included in the analysis. Most of them responded that the nephrologist in-dicates (76.8%) and prescribes (74.5%) continuous renal re-placement therapy (CRRT). The application of the Kidney Disease Improving Global Outcomes (KDIGO) 2 criterion for early start of CRRT used 74.5% of the respondents, and 91.5% of them started late initiation of CRRT in the presence of complications associated with AKI or poor re-sponse to conservative treatment. Regarding the clinical ex-perience of the respondents, 74.5% of them marked the early start of CRRT within 12 hours, whereas 56.4% of them considered the start of CRRT after 48 h as late. The most commonly used modality was continuous venous he-modiafiltration (37.6%). Most participants used heparin as an anticoagulant (95.7%) with an average life span of filters less than 24 h (71.3%) and 25 mL/kg/h efficiency target di-alysis effluent dose (45.2%) during CRRT. The most com-mon complications of CRRT were hypotension (55.3%) and catheter-related infections (29.8%). Conclusion. The ear-ly start of CRRT is considered favorite by the majority of the participants. According to the obtained data, standardi-zation of the strategy in the diagnostics and treatment of AKI is necessary.