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Original article   

Minerva Urology and Nephrology 2022 Mar 11

DOI: 10.23736/S2724-6051.22.04699-7

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Increase of continuous treatments and regional citrate anticoagulation during renal replacement therapy in the ICUs of the north-west of Italy from 2007 to 2015

Filippo MARIANO 1, 2 , Paola INGUAGGIATO 3, Marco POZZATO 4, Ernesto TURELLO 5, Paola DAVID 6, Silvia BERUTTI 7, Massimo MANES 8, Gianluca LEONARDI 1, Massimo GAI 1, Alberto MELLA 1, 2, Giorgio CANEPARI 3, Giacomo FORNERIS 4, Giulia STORACE 5, Maddalena BRUSTIA 6, Valentina PELLÙ 8, Valentina CONSIGLIO 9, Giuliana TOGNARELLI 9, Roberto BONAUDO 10, Bruno GIANOGLIO 10, Andrea CAMPO 11, Giusto VIGLINO 11, Angela MARINO 12, Stefano MAFFEI 12, Elisabetta ROSCINI 13, Giovanni CALABRESE 13, Mauro GHERZI 14, Marco FORMICA 14, Emanuele STRAMIGNONI 15, Mario SALOMONE 15, Guido MARTINA 16, Andrea SERRA 16, Chiara DEAGOSTINI 16, Silvana SAVOLDI 16, Antonio MARCIELLO 17, Vincenzo TODINI 17, Fabio CHIAPPERO 17, Patrizia VIO 18, Maurizio BORZUMATI 18, Luigina COSTANTINI 19, Oliviero FILIBERTI 19, Giulio CESANO 20, Roberto BOERO 20, Corrado VITALE 7, Doriana CHIARINOTTI 6, Marco MANGANARO 5, Luca BESSO 3, Stefano CUSINATO 21, 22, Dario ROCCATELLO 3, 23, Luigi BIANCONE 1, 2

1 Unit of Nephrology, Dialysis and Transplantation, City of Sciences and Health, CTO and Molinette Hospitals, Turin, Italy; 2 Department of Medical Sciences, University of Turin, Turin, Italy; 3 Unit of Nephrology and Dialysis, Santa Croce e Carle Hospital, Cuneo, Italy; 4 Unit of Nephrology and Dialysis, San Giovanni Bosco Hospital, Turin, Italy; 5 Unit of Nephrology and Dialysis, SS Antonio e Biagio Hospital, Alessandria, Italy; 6 Unit of Nephrology and Dialysis, Maggiore Hospital, Novara, Italy; 7 Unit of Nephrology and Dialysis, Mauriziano Hospital, Turin, Italy; 8 Unit of Nephrology and Dialysis, Umberto Parini Hospital, Aosta, Italy; 9 Unit of Dialysis, San Luigi Hospital, Orbassano, Turin, Italy; 10 Unit of Nephrology, Dialysis and Transplantation, OIRM Hospital, Turin, Italy; 11 Unit of Nephrology and Dialysis, San Lazzaro Hospital, Alba, Cuneo, Italy; 12 Unit of Nephrology and Dialysis, Cardinal Massaia Hospital, Asti, Italy; 13 Unit of Nephrology and Dialysis, Casale Monferrato and Novi Ligure Hospitals, Alessandria, Italy; 14 Unit of Nephrology and Dialysis, Savigliano, Mondovi’ and Ceva Hospitals, Cuneo, Italy; 15 Unit of Nephrology and Dialysis, Chieri and Moncalieri Hospitals, Turin, Italy; 16 Unit of Nephrology and Dialysis, Chivasso, Cirié and Ivrea Hospitals, Turin, Italy; 17 Unit of Nephrology and Dialysis, Rivoli and Pinerolo Hospitals, Turin, Italy; 18 Unit of Nephrology and Dialysis, Verbania-Cusio-Ossola Hospitals, Verbania-Cusio-Ossola, Italy; 19 Unit of Nephrology and Dialysis, Sant’Andrea Hospital, Vercelli, Italy; 20 Unit of Nephrology and Dialysis, Martini Hospital, Turin, Italy; 21 Unit of Nephrology and Dialysis, S.S. Trinità Hospital, Borgomanero, Novara, Italy; 22 Piedmont and Aosta Valley Section, Società Italiana di Nefrologia, Rome, Italy; 23 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy


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BACKGROUND: Few reports have addressed the change in Renal Replacement Therapy (RRT) management in the ICUs over the years in western countries. This study aims to assess the trend of dialytic practice in a 4.5-million population-based study of the northwest of Italy.
METHODS: A nine-year survey covering all the RRT provided in the ICUs. Consultant nephrologists of the 26 Nephrology and Dialysis centers reported their activities in the years 2007, 2009, 2012, and 2015.
RESULTS: From 2007 to 2015 the patients treated increased from 1042 to 1139, and the incidence of RRT from 254 to 263 cases/10^6 inhabitants. The workload for Dialysis Center was higher in the larger hub hospitals. RRT for Acute Kidney Injury (AKI), continuation of treatment in chronically dialyzed patients, or extrarenal indications accounted for about the stable rate of 70, 25 and 5% of all RRT sessions, respectively. Continuous modality days increased from 2731 days (39.5%) in 2007 to 5076 (70.6%) in 2015, when the continuous+prolonged treatment days were 6880/7196 (95.6% of total days). As to RRT timing, in 2015 only the classical clinical criteria, and no K-DIGO stage were adopted by most Centers. As to RRT interruption, in 2015 urine volume was the first criterion. Implementation of citrate anticoagulation (RCA) for RRT patients significantly increased from 2.8% in 2007 to 30.9% in 2015, when it was applied in all 26 Centers.
CONCLUSIONS: From 2007 to 2015, current practice has changed towards shared protocols, with increasing continuous modality and RCA implementation.


KEY WORDS: Renal replacement therapy; North-west Italy; Survey; Critically ill patients

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