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Kidney Week

Abstract: PO0056

Survey of US Critical Care Practitioners on Perspectives Toward Net Ultrafiltration Prescription and Practice

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Chen, Huiwen, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Murugan, Raghavan, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background

Previous studies suggest international practice variation in net ultrafiltration (UFNET) among critically ill patients with acute kidney injury treated with kidney replacement therapy. We examined U.S. critical care practitioner attitudes toward UFNETprescription and practice.

Methods

Secondary analysis of a multinational, cross-sectional, internet-assisted, open survey administered to intensivists, nephrologists, advanced practice providers, ICU and dialysis nurses in the U.S.

Results

Of 1,569 international survey respondents, 465 (29.6%) practitioners were from the U.S. Practitioners were mostly nurses and nurse practitioners (58%) and intensivists (38.2%). Median duration of practice was 8.7 (IQR, 4.2-19.4) years and 63.4% practiced in a university- based hospital. Practitioners reported using continuous kidney replacement therapy (CKRT) as the first modality for UFNETin 60% (IQR 20-90%) of their patients with median UFNETrate of 51 mL/h (IQR 25-100 mL/h) for hemodynamically unstable and a maximal rate of 285 mL/h (IQR,200 - 341 mL/h) for hemodynamically stable patients. 58.3% (range 28.7%-79.2%) of practitioners assessed net fluid balance hourly. Hemodynamic instability was reported in 25% (IQR, 10-100%) of the patients, and practitioners decreased the rate of fluid removal (71.2%); started or increased dose of a vasopressor (56.8%); completely stopped fluid removal (44.5%); and administered a fluid bolus (28.7%). Most clinicians (79.8%) reported patient intolerance as a major barrier.Other barriers include frequent interruptions (50.1%), under prescription (17.8%), unavailability of trained staff (17%), inability to titrate fluid removal (10.1%), unavailability of dialysis machines (8.6%) and cost (2.4%) (Figure 1). More than 70% of clinicians agreed with early protocolized fluid removal and expressed desire to enroll their patients in a future clinical trial.

Conclusion

This study provides new knowledge on UFNETin practices in the U.S. We also identified barriers and specific targets for quality improvement initiatives. Our data reflect the need for evidence-based practice guidelines for UFNET.