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The DOse REsponse Multicentre International Collaborative Initiative (DO-RE-MI).

G Monti1, M Herrera, D Kindgen-Milles

  • 1Department of Anesthesiology and Intensive Care, Hospital Niguarda, Milan, Italy, and Anesthesiology Clinic, University of Düsseldorf, Germany. Gianpaola.monti@ospedaleniguarda.it

Contributions to Nephrology
|April 28, 2007
PubMed
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Practices for renal replacement therapy (RRT) in the ICU vary widely. This study found that continuous venovenous hemodiafiltration (CVVHDF) is most common, but delivered doses often fall short of recommended levels, impacting patient outcomes.

Area of Science:

  • Nephrology
  • Intensive Care Medicine
  • Clinical Research

Background:

  • Current practices for renal replacement therapy (RRT) in intensive care units (ICUs) are not well-defined.
  • The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) survey investigates RRT modality selection and performance.
  • This study reports preliminary findings from the first year of recruitment.

Purpose of the Study:

  • To describe current practices in RRT selection and delivery in ICUs.
  • To analyze the delivered RRT dose in relation to patient outcomes.
  • To identify factors contributing to RRT downtime.

Main Methods:

  • An observational, multinational survey (DO-RE-MI) involving 431 patients across 25 centers in 5 countries.

Related Experiment Videos

  • Data collected via electronic case report forms (CRFs) on patient demographics, RRT initiation criteria, modality used, delivered dose, and downtime.
  • Analysis of RRT modalities including continuous venovenous hemodiafiltration (CVVHDF), continuous venovenous hemofiltration (CVVH), intermittent hemodialysis (IHD), and high-volume hemofiltration (HVHF).

    • Main Results:

    • Continuous venovenous hemodiafiltration (CVVHDF) was the most utilized RRT modality (49%), despite significant variability in delivered doses.
    • The RIFLE criteria (38%) and elevated urea/creatinine levels were primary indicators for initiating RRT.
    • Circuit clotting (74%) was the leading cause of RRT interruptions, contributing to significant downtime (8-28%).

    Conclusions:

    • Significant variability exists in RRT modality selection and delivered doses across ICUs.
    • CVVHDF is the predominant RRT method, but delivered doses frequently deviate from the target of 35 ml/h/kg.
    • Circuit clotting and clinical factors are major contributors to RRT downtime, highlighting areas for practice improvement.