Survey of U.S. Critical Care Practitioners on Net Ultrafiltration Prescription and Practice Among Critically Ill Patients Receiving Kidney Replacement Therapy

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).