Current Status of Continuous Renal Replacement Therapy in Japanese Intensive Care Units: A Multicenter Retrospective...

Area of Science:

• Nephrology
• Intensive Care Medicine
• Critical Care

Background:

• Continuous renal replacement therapy (CRRT) is a vital treatment for critically ill patients in intensive care units (ICUs).
• Optimal indications and settings for CRRT remain undetermined, necessitating studies on its current application.
• This study investigates the status of CRRT in Japan.

Purpose of the Study:

• To describe the current status of CRRT in Japan.
• To evaluate the effectiveness of CRRT in managing electrolyte levels, acid-base balance, and uremia in ICU patients.
• To identify common supplementation needs during CRRT.

Main Methods:

• A multicenter retrospective observational study involving 1,045 adult ICU patients from 18 tertiary hospitals in Japan.
• Patients receiving CRRT for less than 24 hours or combined with intermittent renal replacement therapy were excluded.
• Primary outcomes included temporal changes in electrolytes, acid-base balance, and uremic solutes; secondary outcomes were potassium and phosphate supplementation.

Main Results:

• The median CRRT duration was 4.4 days with a median dose of 17.3 mL/kg/h, lower than recommended guidelines.
• Electrolyte levels, acid-base balance, and uremic solutes normalized within 4 days of CRRT.
• Potassium supplementation was given to 70.0% and phosphate supplementation to 39.6% of patients, with persistent hypophosphatemia in 30-50%.

Conclusions:

• The CRRT dose utilized in Japan is below the recommended levels.
• CRRT effectively corrected electrolyte and acid-base abnormalities within 72-96 hours.
• Frequent potassium and phosphate supplementation indicates a need to modify current CRRT solutions.