Renal replacement therapy in Scottish critical care units: A national audit of practices

Large randomised controlled trials show no benefit of high intensity renal replacement therapy compared to lower intensity regimens. Previous data suggest large variation in practice. This audit evaluated practices in relation to intensity of replacement therapy in critical care units across the Scottish National Health Service over a 28-day period. The mean delivered weight-adjusted effluent flow rates for continuous veno-venous haemofiltration were 29.1 (8.1 SD) ml kg(-1) h(-1) which was 89% of that prescribed. For continuous veno-venous haemodiafiltration, the mean delivered dose was 41.3 (7.9) ml kg(-1) h(-1) which was 88.4% of that prescribed. Of the eight patients undergoing intermittent haemodialysis, seven had daily treatments, whilst the eighth had four treatments in five days. The prescription and delivery of renal replacement therapy within Scottish critical care units are routinely performed at an intensity that is higher than necessary. Avoidance of excessive dose could provide important cost savings.