Current worldwide practice of dialysis dose prescription in acute renal failure.
OBJECTIVE
The practice of renal replacement therapy for acute renal failure varies greatly around the world. This is especially true for the dose of renal replacement therapy. This review describes the epidemiology of dialysis prescription and delivery around the world based on recent observational studies and international surveys. Furthermore, a brief speculation on the concept of adequacy of therapy is provided.


RESULTS
Following the publication of the first large prospective randomized trial on the effects of treatment dose on outcome of patients with acute renal failure a certain consensus has been achieved on the adequacy of 35 ml/kg/h of clearance in continuous therapies. Surveys conducted in 1998 had demonstrated that such adequate therapy was only prescribed in a minority of patients. Recent observations based on questionnaires and surveys confirm that the number of centers prescribing adequate dialysis dose is increasing, but there is still a large number of institutions where prescription is made with no specific adequacy targets and effective delivery is not measured. Several barriers have been identified to reach adequacy targets including logistics, costs, personnel and others.


CONCLUSIONS
The analysis of the epidemiology of dialysis dose around the world shows a complex picture. Wide variations in practice are present although a significant effort has been made to standardize the prescription and delivery of therapy.
Ronco
Claudio
C
Department of Nephrology, Dialysis and Transplantation, S. Bortolo Hospital, Vicenza, Italy. cronco@goldnet.it
Ricci
Zaccaria
Z
Bellomo
Rinaldo
R
D058186:Acute Kidney Injury / Q000628:therapy*; D019540:Area Under Curve; D006801:Humans; D006435:Renal Dialysis / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods*; D012720:Severity of Illness Index; D013778:Tetrazolium Salts; D014508:Urea / Q000097:blood
D013778:Tetrazolium Salts; C013574:iodonitrotetrazolium; D014508:Urea