TENDENCY TO PRESCRIBE EXCESSIVE EFFLUENT DOSES FOR CONTINUOUS RENAL REPLACEMENT THERAPY IN OUR MEDIUM-SIZED INTENSIVE CARE UNIT

F REIMANN1, M ROWLAND1, B SEIDEL1, S KHAN1, M BASTICK1
11Intensive Care Unit, Gosford Hospital, Central Coast Local Health District, New South Wales, Australia,

Aim: To evaluate effluent dose prescriptions of continuous veno-venous haemodiafiltration (CVVHDF) in adult patients with acute kidney injury (AKI) in our 15-bed intensive care unit (ICU).
Background: An effluent dose of 25 to 30 mL/kg/hr is routinely recommended for CVVHDF, although a higher dose may be used to correct severe acidosis or hyperkalaemia.
Methods: Records of all patients who underwent continuous renal replacement therapy (CRRT) over a nine month period in 2017 at Gosford Hospital were retrospectively analysed.
Results: Twenty nine patients received CRRT, performed as CVVHDF, with a mean duration of 64 hours. The mean effluent dose prescribed and delivered was 32.7 mL/kg/hr with a standard deviation of 11.0 mL/kg/hr. Of nine patients (31.0 %) who received a dose above 35 mL/kg/hr, only five patients (55.6 %) had an appropriate indication (serum pH less than 7.1 or serum potassium above 7.0 mmol/L). A dose less than 20 mL/kg/hr was initially prescribed and delivered for two patients (6.9 %). Of the eleven patients with very high or very low dose CRRT prescriptions, appropriate dose adjustments were subsequently made for seven patients (63.6 %).
Conclusions: There was a tendency to prescribe excessive effluent doses for CVVHDF in patients with AKI in our ICU. A small number of patients was under-dialysed. The clinical significance of these aberrations is uncertain. An educational program and decision-making tool has been introduced to guide prescribing practice.


Biography:
Graduated from Medicine in Germany in 2002. Completed Physician training in 2017 with RACP fellowship in Nephrology. Current post-fellowship training in General and Acute Care Medicine

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