How and when do we use continuous renal replacement therapy for acute kidney injury in Serbia? – The multicentric survey

Violeta Knežević; Dejan Ćelić; Tijana Azaševac; Sonja Golubović; Vesna Sladojević; Nataša Nestorov; Djoko Maksić; Radomir Naumović; Tatjana Lazarević; Vojislava Nešković

doi:10.2298/VSP191231110K

Violeta Knežević University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Dejan Ćelić University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Tijana Azaševac University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Sonja Golubović University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Vesna Sladojević University Clinical Center of Vojvodina, Emergency Center, Novi Sad, Serbia
Nataša Nestorov University Clinical Center of Vojvodina, Clinic for Anesthesia and Intensive Care, Novi Sad, Serbia
Djoko Maksić Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
Radomir Naumović Zvezdara University Medical Center, Clinical Department of Renal Diseases, Belgrade, Serbia
Tatjana Lazarević University Clinical Center of Kragujevac, Department of Nephrology and Dialysis, Kragujevac, Serbia University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Vojislava Nešković Military Medical Academy, Clinic for Anesthesiology and Intensive Therapy, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia;

DOI: https://doi.org/10.2298/VSP191231110K

Keywords: acute kidney injury;, nephrologists;, renal replacement therapy;, continuous renal replacement therapy;, surveys and questionnaires.

Abstract

Background/Aim. The absence of clear guidance in the definition, diagnostics, and indications for renal replacement treatment (RRT) is present. The aim of this study was to help outlining future clinical work in improving the treatment outcome and reducing complications of acute kidney injury (AKI) based on the current clinical practice. Methods. The questionnaires were distributed among physicians of different specialties who participated voluntarily and anonymously. The questionnaire was drawn up in accordance with the standard clinical practice. Results. We conducted a multicentric web survey among nephrologists (46.8%) and other physicians in Serbia. The sample consisted of 119 participants, out of which 78.9% filled out the survey forms correctly and were, therefore, included in the analysis. Most of them responded that the nephrologist indicates (76.8%) and prescribes (74.5%) continuous renal replacement therapy (CRRT). The application of the Kidney Disease Improving Global Outcomes (KDIGO) 2 criterion for “early” start of CRRT used 74.5% of the respondents, and 91.5% of them started “late” initiation of CRRT in the presence of complications associated with AKI or poor response to conservative treatment. Regarding the clinical experience of the respondents, 74.5% of them marked the “early” start of CRRT within 12 hours, whereas 56.4% of them considered the start of CRRT after 48 h as “late”. The most commonly used modality was continuous venous hemodiafiltration (37.6%). Most participants used heparin as an anticoagulant (95.7%) with an average life span of filters less than 24 h (71.3%) and 25 mL/kg/h efficiency target dialysis effluent dose (45.2%) during CRRT. The most common complications of CRRT were hypotension (55.3%) and catheter-related infections (29.8%). Conclusion. The “early” start of CRRT is considered favorite by the majority of the participants. According to the obtained data, standardization of the strategy in the diagnostics and treatment of AKI is necessary.

Author Biographies

Violeta Knežević, University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

nephrologist

Dejan Ćelić, University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

nephrologist

Tijana Azaševac, University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

nephrologist

Sonja Golubović, University Clinical Center of Vojvodina, Clinic for Nephrology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

physician

Vesna Sladojević, University Clinical Center of Vojvodina, Emergency Center, Novi Sad, Serbia

physician

Nataša Nestorov, University Clinical Center of Vojvodina, Clinic for Anesthesia and Intensive Care, Novi Sad, Serbia

anesthesiologist

Djoko Maksić, Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia

nephrologist

Radomir Naumović, Zvezdara University Medical Center, Clinical Department of Renal Diseases, Belgrade, Serbia

nephrologist

Tatjana Lazarević, University Clinical Center of Kragujevac, Department of Nephrology and Dialysis, Kragujevac, Serbia University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

nephrologist

Vojislava Nešković, Military Medical Academy, Clinic for Anesthesiology and Intensive Therapy, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia;

anesthesiologist

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