Monard Céline, Marel Arnaud, Joannidis Michael, Ostermann Marlies, Peng Zhiyong, Doi Kent, De Rosa Silvia, Bobek Ilona, Sokolov Dmitry, Wu Vin-Cent, Premuzic Vedran, Mehta Ravindra, Bellomo Rinaldo, Garcia Xaime, Pizarro Camilo, Zarbock Alexander, Milet Igor, Reis Thiago, Romain Marc, Mc Nicholas Bairbre, Schneider Antoine, Rimmelé Thomas
Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France.
Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
J Crit Care. 2025 Aug;88:155076. doi: 10.1016/j.jcrc.2025.155076. Epub 2025 Apr 3.
Up to 14 % of critically ill patients receive renal replacement therapy (RRT) during their ICU stay and are treated with intermittent hemodialysis (IHD) or one of the continuous renal replacement therapy (CRRT) techniques. The choice of a modality (IHD or CRRT) and technique (continuuous veno-venous -hemodialysis (CVVHD), -hemofiltration (CVVH), or - hemodiafiltration (CVVHDF)), and the way it is delivered, may have an impact on outcomes but only few studies addressed this question. We aimed to survey the availability, settings, and clinicians' preferences regarding RRT modalities and techniques in critically ill patients.
Between July 2021 and March 2022, we conducted an open online worldwide survey targeting ICU clinicians and consisting of 31 questions.
Among the 1174 participants from 73 countries, 94 % indicated their ability to initiate RRT at any time. CRRT was more widely available than IHD (97 % vs 85 %). CVVHDF was the most frequently used CRRT technique (59 %), followed by CVVHD (26 %) and CVVH (16 %). Most participants (70 %) reported having access to at least two CRRT techniques in their unit. Preference for IHD or CRRT varied greatly, depending on the clinical situation. Among CRRT techniques, CVVHD was preferred for removal of small-sized molecules, better hemofilter lifespan and reduced nursing workload. The preferential indications for CVVH included septic shock, removal of middle-sized molecules and fluid overload. The technical settings for CVVH and CVVHDF were very heterogeneous.
This international survey underscores the large diversity in RRT practices wordlwide, as well as heterogeneity in beliefs and preferences among intensivists. These data highlight the need for robust comparative trials to identify the optimal RRT modality and technique to improve outcomes in specific clinical situations.
高达14%的重症患者在重症监护病房（ICU）住院期间接受肾脏替代治疗（RRT），并采用间歇性血液透析（IHD）或连续性肾脏替代治疗（CRRT）技术之一进行治疗。治疗方式（IHD或CRRT）和技术（连续性静脉 - 静脉血液透析（CVVHD）、血液滤过（CVVH）或血液透析滤过（CVVHDF））的选择及其实施方式可能会对治疗结果产生影响，但只有少数研究探讨了这个问题。我们旨在调查重症患者RRT方式和技术的可用性、设置情况以及临床医生的偏好。
在2021年7月至2022年3月期间，我们针对ICU临床医生开展了一项全球范围内的开放式在线调查，该调查包含31个问题。
在来自73个国家的1174名参与者中，94%表示他们能够随时启动RRT。CRRT比IHD更广泛可用（97%对85%）。CVVHDF是最常用的CRRT技术（59%），其次是CVVHD（26%）和CVVH（16%）。大多数参与者（70%）报告称其所在科室至少可使用两种CRRT技术。对IHD或CRRT的偏好因临床情况而异。在CRRT技术中，CVVHD因能清除小分子物质、具有更长的血液滤过器使用寿命以及减少护理工作量而更受青睐。CVVH的优先适应证包括感染性休克、清除中分子物质和液体超负荷。CVVH和CVVHDF的技术设置非常多样化。
这项国际调查强调了全球范围内RRT实践的巨大差异，以及重症医学专家在观念和偏好上的异质性。这些数据凸显了开展有力的对比试验以确定最佳RRT方式和技术从而改善特定临床情况下治疗结果的必要性。
