Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose.
OBJECTIVE
The study aims to describe the use of dialysis catheters in critically ill patients treated with continuous renal replacement therapy (CRRT) and to study the impact of femoral versus non-femoral access on CRRT dose.


METHODS
Statistical analysis and predictive modelling of data from the Randomized Evaluation of Normal vs. Augmented Level renal replacement therapy trial.


RESULTS
The femoral vein was the first access site in 937 (67%) of 1,399 patients. These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores (p = 0.009) and lower pH (p < 0.001) but similar mortality to patients with non-femoral access (44 vs. 45%; p = 0.63). Lower body weight was independently associated with femoral access placement (OR 0.97, 95% CI 0.96-0.98). Femoral access was associated with a 1.03% lower CRRT dose (p = 0.05), but a 4.20% higher dose was achieved with 13.5 Fr catheters (p = 0.03).


CONCLUSIONS
Femoral access was preferred in lighter and sicker patients. Catheter gauge had greater impact than catheter site in CRRT dose delivery. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=439581.
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Level 6, Melbourne, Vic., Australia.
Rinaldo
R
Bellomo
Johan
J
Mårtensson
Serigne
S
Lo
Kirsi-Maija
KM
Kaukonen
Alan
A
Cass
Martin
M
Gallagher
D058186:Acute Kidney Injury / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D016638:Critical Illness; D005260:Female; D005268:Femoral Vein; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000295:instrumentation / Q000379:methods*; D016019:Survival Analysis