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What is 'BEST' RRT practice?

Shigehiko Uchino1

  • 1Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.

Contributions to Nephrology
|April 30, 2010
PubMed
Summary
This summary is machine-generated.

Renal replacement therapy (RRT) for acute kidney injury (AKI) varies widely worldwide. This practice variation may negatively impact patient outcomes, highlighting the need for standardized RRT protocols in critical care settings.

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Epidemiology

Background:

  • Acute kidney injury (AKI) is a frequent complication in critical illnesses, often necessitating renal replacement therapy (RRT).
  • Hospital mortality for patients requiring RRT exceeds 60%, underscoring the importance of optimizing RRT for severe AKI.
  • Diverse RRT modes and delivery methods exist, potentially influencing efficacy and safety, prompting calls for research into technical aspects.

Purpose of the Study:

  • To address the Acute Dialysis Quality Initiative's (ADQI) recommendation for research into technical aspects of RRT.
  • To understand multiple facets of AKI and RRT practices internationally through the BEST Kidney study.
  • To analyze variations in RRT practices, including intermittent RRT (IRRT) versus continuous RRT (CRRT), timing, and global CRRT approaches.

Main Methods:

  • A multicenter, multinational, prospective epidemiological study (BEST Kidney study).
  • Involved 54 centers across 23 countries from September 2000 to December 2001.
  • Included over 1,700 patients, with 1,260 receiving RRT, to analyze RRT practices.

Main Results:

  • Significant global variations in RRT practices were observed.
  • Current RRT practices are not consistently aligned with existing evidence.
  • Practice variations in RRT may contribute to considerable patient morbidity.

Conclusions:

  • The BEST Kidney Study identified substantial heterogeneity in RRT delivery for AKI patients.
  • RRT practice variations may be linked to adverse patient outcomes.
  • Generated hypotheses for future clinical trials to reduce practice variations and improve AKI patient care.