Continuous renal replacement therapy: current practice in Australian and New Zealand intensive care units

Large multicentre studies of continuous renal replacement therapy (CRRT) in critically ill patients may influence its bedside prescription and practical application. Despite this, many aspects of CRRT may not be informed by evidence but remain a product of clinician preference. Little was known about current CRRT practice in Australia and New Zealand and it is not known if the evidence from recent studies has been integrated into practice.

A prospective online survey of CRRT practice was sent to intensive care unit medical and nursing clinicians via three national databases in Australian and New Zealand ICUs in December 2013 to March 2014.

There were 194 respondents from 106 ICUs; 49 ICUs (47%) were in tertiary metropolitan hospitals. One hundred and two respondents (54%) reported continuous venovenous haemodiafiltration as the most common CRRT technique, with a combination of predilution and postdilution of CRRT solutions. The prescription for CRRT was variable, with respondents indicating preferences for therapy based on L/hour (53%) or a weight-adjusted treatment in mL/kg/hour (47%). For all modes of CRRT, the common blood flow rates applied were 151-200mL/ minute and 201-250mL/minute. Few respondents reported preferring flow rates < 150 mL/minute or > 300mL/minute. Unfractionated heparin was the most commonly used anticoagulant (83%), followed by regional citrate. Femoral vein vascular access was preferred and, typically, a 20 cm length catheter was used. Bard Niagara and Arrow catheters were most frequently used. The Gambro Prismaflex was the dominant machine used (71%).

Our results provide insight into existing clinical management of CRRT. There is considerable variation in the prescription of CRRT in Australian and New Zealand ICUs.