title: Renal replacement therapy in intensive care units: a survey of nephrological practice in northwest Italy.
abstract: BACKGROUND
  Few reports have addressed how current practice reflects uncertainty as to the optimal management of renal replacement therapy (RRT) in Western countries. Current dialytic practice for 2007 in the northwest of Italy was assessed.
  
  
  METHODS
  A total of 24 nephrology and dialysis centers covering all of the RRT provided in the intensive care units (ICUs) in northwest Italy took part in the survey. Consultant nephrologists of each center reported their own activities throughout the year 2007 by an e-mailed questionnaire.
  
  
  RESULTS
  RRT for a total of 7,842 days was provided by 24 dialysis centers in 79 ICUs for 1,118 patients. RRT median duration (5.76 days/patient) increased with the increasing number of hospital ICU beds. Of the RRT cases, 69.9% were due to acute kidney injury, 23.6% for continuation of a treatment in chronic dialysis patients and 4.2% for extrarenal indications. More than 90% of the patients were treated with high permeability membranes, at a median target dosage of 35.0 ml/kg per hour in continuous (39.4%) or extended modality (6-14 hours, 38.5%). Unfractionated heparin was the most common anticoagulant used (67.5%, median 500 IU/hour). In patients at high risk of bleeding, RRT without or with heparin at low-dose + saline flushes was the most commonly adopted line of treatment, followed by citrate (18% of days of dialysis). The decision to start RRT was made by nephrologists alone or in collaboration with intensivists, whereas dose prescriptions were given by nephrologists alone.
  
  
  CONCLUSIONS
  This survey may represent a useful starting point for further research into changes in RRT practice and the adoption of common, shared protocols.
authors.affiliation: Nephrology and Dialysis Unit, CTO Hospital, Turin, Italy. filippo.mariano@poste.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Mariano
authors.forename: Marco
authors.initials: M
authors.lastname: Pozzato
authors.forename: Giorgio
authors.initials: G
authors.lastname: Canepari
authors.forename: Corrado
authors.initials: C
authors.lastname: Vitale
authors.forename: Francesca
authors.initials: F
authors.lastname: Bermond
authors.forename: Colombano
authors.initials: C
authors.lastname: Sacco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Amore
authors.forename: Massimo
authors.initials: M
authors.lastname: Manes
authors.forename: Carlo
authors.initials: C
authors.lastname: Navino
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D002908:Chronic Disease; D019538:Health Care Surveys; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants; D006493:Heparin