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dc.contributor.authorLedoux-Hutchinson, Lawrence
dc.contributor.authorWald, Ron
dc.contributor.authorMalbrain, Manu
dc.contributor.authorCarrier, François Martin
dc.contributor.authorBagshaw, Sean M.
dc.contributor.authorBellomo, Rinaldo
dc.contributor.authorAdhikari, Neill K. J.
dc.contributor.authorGallagher, Martin
dc.contributor.authorSilver, Samuel A.
dc.contributor.authorBouchard, Josée
dc.contributor.authorConnor, Michael J. Jr.
dc.contributor.authorClark, Edward G.
dc.contributor.authorCôté, Jean-Maxime
dc.contributor.authorNeyra, Javier A.
dc.contributor.authorDenault, André
dc.contributor.authorBeaubien-Souligny, William
dc.publisherLippincott, Williams and Wilkinsfr
dc.titleFluid management for critically Ill patients with acute kidney injury receiving kidney replacement therapy : an international surveyfr
dc.contributor.affiliationUniversité de Montréal. Faculté de médecinefr
dcterms.abstractBackground In critically ill patients receiving kidney replacement therapy (KRT), high ultrafiltration rates and persistent fluid accumulation are associated with adverse outcomes. The purpose of this international survey was to evaluate current practices and evidence gaps related to fluid removal with KRT in critically ill patients. Methods This was a multinational, web-based survey distributed by 7 networks comprising nephrologists and intensivists. Physicians involved in the care of critically ill patients were invited to complete a 39 question survey about fluid-management practices on KRT. The survey was distributed from September 2021 to December 2021. Results There were 757 respondents from 96 countries (response rate of 65%). Most respondents practiced adult medicine (89%) and worked in an academic center (69%). The majority (91%) reported aiming for a 0.5 to 2 L negative fluid balance per day when fluid removal is indicated, although there was important variability in what respondents considered a safe maximal target. Intensivists were more likely than nephrologists to use adjunct volume status assessment methods (i.e. ultrasound, hemodynamic markers, intra-abdominal pressure) while nephrologists were more likely to deploy co-interventions aimed at improving tolerance to fluid removal (i.e. osmotic agents, low-temperature dialysate). There was a broad consensus that rapid decongestion should be prioritized when fluid accumulation is present, but the prevention of hypotension was also reported as a competing priority. A majority (77%) agreed that performing trials that compare fluid management strategies would be ethical and clinically relevant. Conclusions We have identified multiple areas of variability in current practice of fluid management for patients receiving KRT. The majority of nephrologists and intensivists agreed that several knowledge gaps related to fluid removal strategies should be investigated in future randomized controlled
UdeM.ReferenceFournieParDeposantLedoux-Hutchinson L, Wald R, Malbrain MLNG, Carrier FM, Bagshaw SM, Bellomo R, Adhikari NKJ, Gallagher M, Silver SA, Bouchard J, Connor MJ Jr, Clark EG, Côté JM, Neyra JA, Denault A, Beaubien-Souligny W. Fluid Management for Critically Ill Patients with Acute Kidney Injury Receiving Kidney Replacement Therapy: An International Survey. Clin J Am Soc Nephrol. 2023 Mar 28. doi: 10.2215/CJN.0000000000000157. Epub ahead of print. PMID:
UdeM.VersionRioxxVersion acceptée / Accepted Manuscriptfr
oaire.citationTitleClinical journal of the American society of nephrologyfr

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