title: [Treatment of acute renal failure in Germany: Analysis of current practice].
abstract: OBJECTIVE
  There are currently no reliable data on the differential use of renal replacement therapy (RRT) options for critically ill patients with acute renal failure in Germany.
  
  
  METHODS
  A questionnaire-based survey was delivered to 2265 German intensive care units. The questionnaire contained 19 questions regarding RRT.
  
  
  RESULTS
  A total of 423 German intensive care units participated in the survey. The offered modalities of RRT varied significantly: the smaller the facility, the fewer different RRT options were available. Intermittent dialysis procedures were available in only 35% of hospitals with up to 400 beds. In university hospitals, hemodynamically unstable patients were exclusively treated by continuous RRT, whereas in hospitals with up to 400 beds, intermittent RRT was also used. In addition, treatment practice was also dependent on the specialization of the treating physicians: Isolated acute renal failure was treated more often intermittently by nephrologists compared to anesthesiologists (79.7 vs. 43.3%). Nephrologists also used extracorporeal RRT more often in cardiorenal syndrome (54.3 vs. 35.8%), whereas anesthesiologists preferred them in sepsis (37.3 vs. 23.1%). The choice of anticoagulant varied as well: Hospitals with up to 400 beds offered regional citrate anticoagulation in only 50% compared to 90% of university hospitals.
  
  
  CONCLUSIONS
  Currently, RRT treatment in acute renal failure on German intensive care units seems to be dependent on the size, local structures, and education of the intensivists rather than patient needs. Our results demonstrate the necessity to establish cross-disciplinary standards for the treatment of acute renal failure in German intensive care units.
authors.affiliation: Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen gGmbH, Akademisches Lehrkrankenhaus Universität Köln, Gotenstraße 1, 42653, Solingen, Deutschland, schmitz.m@klinikumsolingen.de.
authors.forename: M
authors.initials: M
authors.lastname: Schmitz
authors.forename: P J
authors.initials: PJ
authors.lastname: Heering
authors.forename: R
authors.initials: R
authors.lastname: Hutagalung
authors.forename: R
authors.initials: R
authors.lastname: Schindler
authors.forename: M I
authors.initials: MI
authors.lastname: Quintel
authors.forename: F M
authors.initials: FM
authors.lastname: Brunkhorst
authors.forename: S
authors.initials: S
authors.lastname: John
authors.forename: A
authors.initials: A
authors.lastname: Jörres
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D059347:Cardio-Renal Syndrome / Q000628:therapy; D006276:Health Facility Size; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D006435:Renal Dialysis / Q000379:methods*; D018805:Sepsis / Q000628:therapy
chemical_list: D000925:Anticoagulants
references.citation: Crit Care Med. 2012 Apr;40(4):1164-70
references.pmid: 22067631
references.citation: Anaesth Intensive Care. 2007 Aug;35(4):529-35
references.pmid: 18020071
references.citation: Intensive Care Med. 1997 Mar;23(3):288-96
references.pmid: 9083231
references.citation: J Intensive Care Med. 2013 Sep-Oct;28(5):281-95
references.pmid: 22027760
references.citation: J Am Soc Nephrol. 2013 Jan;24(1):37-42
references.pmid: 23222124
references.citation: BMC Nephrol. 2013 Apr 18;14:89
references.pmid: 23597045
references.citation: Nat Rev Nephrol. 2011 Apr;7(4):209-17
references.pmid: 21343898
references.citation: Crit Care. 2000;4(2):69-71
references.pmid: 11094495
references.citation: Semin Dial. 2009 Mar-Apr;22(2):151-4
references.pmid: 19426419
references.citation: Semin Thromb Hemost. 2015 Feb;41(1):49-60
references.pmid: 25590528
references.citation: J Crit Care. 2014 Aug;29(4):650-5
references.pmid: 24636927
references.citation: Lancet. 2000 Jul 1;356(9223):26-30
references.pmid: 10892761
references.citation: Nephrol Dial Transplant. 2011 Jan;26(1):232-9
references.pmid: 20876598
references.citation: Dtsch Med Wochenschr. 2014 Feb;139(7):e1-8
references.pmid: 24496900
references.citation: Crit Care Med. 2009 Jun;37(6):2018-24
references.pmid: 19384210
references.citation: J Crit Care. 2010 Mar;25(1):120-7
references.pmid: 19427760
references.citation: Intensive Care Med. 2013 Jan;39(1):101-8
references.pmid: 23001448
references.citation: Am J Kidney Dis. 2006 Nov;48(5):806-11
references.pmid: 17060000
references.citation: Crit Care. 2014 Aug 16;18(4):472
references.pmid: 25128022
references.citation: Dtsch Med Wochenschr. 2014 Aug;139(34-35):1701-6
references.pmid: 25116018
references.citation: Nephrol Ther. 2014 Jul;10(4):203-9
references.pmid: 24997009
references.citation: JAMA. 2005 Aug 17;294(7):813-8
references.pmid: 16106006
references.citation: Kidney Int. 2012 Mar;81(5):442-8
references.pmid: 22113526
references.citation: Nephrol Dial Transplant. 2013 Dec;28(12):2940-5
references.pmid: 24121762
references.citation: J Crit Care. 2002 Dec;17(4):246-50
references.pmid: 12501152
references.citation: Kidney Int. 2001 Apr;59(4):1510-9
references.pmid: 11260415
references.citation: QJM. 2012 Jan;105(1):33-9
references.pmid: 21859774