Introduction: The current prescription and practice of net ultrafiltration among critically ill patients receiving kidney replacement therapy in the U.S. are unclear.
Aim of the study: To assess the attitudes of U.S. critical care practitioners on net ultrafiltration (UF_NET) prescription and practice among critically ill patients with acute kidney injury treated with kidney replacement therapy.
Methods: A secondary analysis was conducted of a multinational survey of intensivists, nephrologists, advanced practice providers, and ICU and dialysis nurses practising in the U.S.
Results: Of 1,569 respondents, 465 (29.6%) practitioners were from the U.S. Mainly were nurses and advanced practice providers (58%) and intensivists (38.2%). The median duration of practice was 8.7 (IQR, 4.2-19.4) years. Practitioners reported using continuous kidney replacement therapy (as the first modality in 60% (IQR 20%-90%) for UF_NET. It was found that there was a significant variation in assessment of prescribed-to-delivered dose of UF_NET, use of continuous kidney replacement therapy for UF_NET, methods used to achieve UF_NET, and assessment of net fluid balance during continuous kidney replacement therapy. There was also variation in interventions performed for managing hemodynamic instability, perceived barriers to UF_NET, belief that early and protocol-based fluid removal is beneficial, and willingness to enroll patients in a clinical trial.
Conclusions: There was considerable practice variation in UF_NET among critical care practitioners in the U.S., reflecting the need to generate evidence-based practice guidelines for UF_NET.