The DOse REsponse Multicentre International Collaborative Initiative (DO-RE-MI).
BACKGROUND
Current practices for renal replacement therapy (RRT) in ICU remain poorly defined. The observational DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) survey addresses the issue of how the different modes of RRT are currently chosen and performed. The primary endpoint of DO-RE-MI will be the delivered dose versus in ICU, 28-day, and hospital mortality, and the secondary endpoint, the hemodynamic response to RRT. Here, we report the first preliminary descriptive analysis after 1-year recruitment.


METHODS
Data from 431 patients in need of RRT with or without acute renal failure (mean age 61.2+15.9) from 25 centers in 5 countries (Spain, Italy, Germany, Portugal, France) were entered in electronic case report forms (CRFs) available via the website acutevision.net.


RESULTS
On admission, 51% patients came from surgery, 36% from the emergency department, and 16% from internal medicine. On admission, mean SOFA and SAPS II were 13 and 50, respectively. The first criteria to initiate RRT was the RIFLE in 38% (failure: 70%, injury: 25%, risk: 22%), the second the high urea/creatinine, and the third immunomodulation. A total of 3,010 cumulative CRF were reported: continuous venovenous hemodiafiltration (CVVHDF) 60%, continuous venovenous hemofiltration (CVVH) 15%, intermittent hemodialysis (IHD) 15%, high-volume hemofiltration (HVHF) 7%, continuous venovenous hemodialysis (CVVHD) 1%, and coupled plasma filtration adsorption/CVVD 2%. In 15% of cases, the patient was shifted to another modality. Mean blood flow rates (ml/min) in the different modalities were: 145 (CVVHDF), 200 (CVVH), 215 (IHD), 283 (HVHF), and 150 (CVVHD). Downtime ranged from 8 to 28% of the total treatment time. Clotting of the circuit accounted for 74% of treatment interruptions.


CONCLUSIONS
Despite a large variability in the criteria of choice of RRT, CVVHDF remains the most used (49%). Clotting and clinical reasons were the most common causes for RRT downtime. In continuous RRT, a large variability in the delivered dose is observed in the majority of patients and often in the same patient from one day to another. Preliminary analysis suggests that in a large number of cases the delivered dose is far from the 'adequate' 35 ml/h/kg.
Monti
G
G
Department of Anesthesiology and Intensive Care, Hospital Niguarda, Milan, Italy, and Anesthesiology Clinic, University of Düsseldorf, Germany. Gianpaola.monti@ospedaleniguarda.it
Herrera
M
M
Kindgen-Milles
D
D
Marinho
A
A
Cruz
D
D
Mariano
F
F
Gigliola
G
G
Moretti
E
E
Alessandri
E
E
Robert
R
R
Ronco
C
C
D058186:Acute Kidney Injury / Q000145:classification / Q000209:etiology / Q000628:therapy*; D000368:Aged; D023381:Endpoint Determination; D005060:Europe; D006306:Health Surveys; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D007391:International Cooperation; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications / Q000628:therapy