Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose

Blood Purif. 2016;41(1-3):11-7. doi: 10.1159/000439581. Epub 2015 Oct 20.

Abstract

Aims: The study aims to describe the use of dialysis catheters in critically ill patients treated with continuous renal replacement therapy (CRRT) and to study the impact of femoral versus non-femoral access on CRRT dose.

Methods: Statistical analysis and predictive modelling of data from the Randomized Evaluation of Normal vs. Augmented Level renal replacement therapy trial.

Results: The femoral vein was the first access site in 937 (67%) of 1,399 patients. These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores (p = 0.009) and lower pH (p < 0.001) but similar mortality to patients with non-femoral access (44 vs. 45%; p = 0.63). Lower body weight was independently associated with femoral access placement (OR 0.97, 95% CI 0.96-0.98). Femoral access was associated with a 1.03% lower CRRT dose (p = 0.05), but a 4.20% higher dose was achieved with 13.5 Fr catheters (p = 0.03).

Conclusions: Femoral access was preferred in lighter and sicker patients. Catheter gauge had greater impact than catheter site in CRRT dose delivery. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=439581.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / pathology
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / therapy*
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Catheterization / instrumentation
  • Catheterization / methods*
  • Catheters
  • Critical Illness
  • Female
  • Femoral Vein*
  • Fluid Therapy / methods
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Replacement Therapy / instrumentation
  • Renal Replacement Therapy / methods*
  • Survival Analysis