Schmitz M, Heering P J, Hutagalung R, Schindler R, Quintel M I, Brunkhorst F M, John S, Jörres A
Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen gGmbH, Akademisches Lehrkrankenhaus Universität Köln, Gotenstraße 1, 42653, Solingen, Deutschland,
Med Klin Intensivmed Notfmed. 2015 May;110(4):256-63. doi: 10.1007/s00063-015-0014-2. Epub 2015 Mar 28.
There are currently no reliable data on the differential use of renal replacement therapy (RRT) options for critically ill patients with acute renal failure in Germany.
A questionnaire-based survey was delivered to 2265 German intensive care units. The questionnaire contained 19 questions regarding RRT.
A total of 423 German intensive care units participated in the survey. The offered modalities of RRT varied significantly: the smaller the facility, the fewer different RRT options were available. Intermittent dialysis procedures were available in only 35% of hospitals with up to 400 beds. In university hospitals, hemodynamically unstable patients were exclusively treated by continuous RRT, whereas in hospitals with up to 400 beds, intermittent RRT was also used. In addition, treatment practice was also dependent on the specialization of the treating physicians: Isolated acute renal failure was treated more often intermittently by nephrologists compared to anesthesiologists (79.7 vs. 43.3%). Nephrologists also used extracorporeal RRT more often in cardiorenal syndrome (54.3 vs. 35.8%), whereas anesthesiologists preferred them in sepsis (37.3 vs. 23.1%). The choice of anticoagulant varied as well: Hospitals with up to 400 beds offered regional citrate anticoagulation in only 50% compared to 90% of university hospitals.
Currently, RRT treatment in acute renal failure on German intensive care units seems to be dependent on the size, local structures, and education of the intensivists rather than patient needs. Our results demonstrate the necessity to establish cross-disciplinary standards for the treatment of acute renal failure in German intensive care units.
目前在德国，对于患有急性肾衰竭的重症患者，尚无关于肾替代治疗（RRT）不同选择使用情况的可靠数据。
向2265个德国重症监护病房发放了基于问卷的调查。问卷包含19个关于RRT的问题。
共有423个德国重症监护病房参与了调查。所提供的RRT方式差异显著：机构规模越小，可用的不同RRT选择越少。在床位多达400张的医院中，仅有35%的医院提供间歇性透析程序。在大学医院，血流动力学不稳定的患者仅接受连续性RRT治疗，而在床位多达400张的医院中，也会使用间歇性RRT。此外，治疗实践还取决于治疗医师的专业：与麻醉医师相比，肾病学家更常采用间歇性治疗孤立性急性肾衰竭（79.7%对43.3%）。肾病学家在心肺肾综合征中也更常使用体外RRT（54.3%对35.8%），而麻醉医师在脓毒症中更倾向于使用（37.3%对23.1%）。抗凝剂的选择也有所不同：床位多达400张的医院仅有50%提供局部枸橼酸抗凝，而大学医院这一比例为90%。
目前，德国重症监护病房中急性肾衰竭的RRT治疗似乎取决于重症监护医师的规模、当地结构和教育背景，而非患者需求。我们的结果表明，有必要为德国重症监护病房中急性肾衰竭的治疗制定跨学科标准。
