Renal replacement therapy practices for patients with acute kidney injury in China
Publication Date
July 10, 2017
Authors
William R. Clark, Xiaoqiang Ding, Haibo Qiu, Zhaohui Ni, et al
Volume
12
Issue
7
Pages
e0178509
DOI
https://dx.plos.org/10.1371/journal.pone.0178509
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0178509
Scopus
85022336890
Mendeley
http://www.mendeley.com/research/renal-replacement-therapy-practices-patients-acute-kidney-injury-china
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Mendeley | Further Information

{"title"=>"Renal replacement therapy practices for patients with acute kidney injury in China", "type"=>"journal", "authors"=>[{"first_name"=>"William R.", "last_name"=>"Clark", "scopus_author_id"=>"7403515831"}, {"first_name"=>"Xiaoqiang", "last_name"=>"Ding", "scopus_author_id"=>"25947382100"}, {"first_name"=>"Haibo", "last_name"=>"Qiu", "scopus_author_id"=>"7201608869"}, {"first_name"=>"Zhaohui", "last_name"=>"Ni", "scopus_author_id"=>"12040759200"}, {"first_name"=>"Ping", "last_name"=>"Chang", "scopus_author_id"=>"55748150600"}, {"first_name"=>"Ping", "last_name"=>"Fu", "scopus_author_id"=>"56507919900"}, {"first_name"=>"Jiarui", "last_name"=>"Xu", "scopus_author_id"=>"57191442405"}, {"first_name"=>"Min Min", "last_name"=>"Wang", "scopus_author_id"=>"57194799637"}, {"first_name"=>"Li", "last_name"=>"Yang", "scopus_author_id"=>"57198987384"}, {"first_name"=>"Jing", "last_name"=>"Wang", "scopus_author_id"=>"57200017978"}, {"first_name"=>"Claudio", "last_name"=>"Ronco", "scopus_author_id"=>"55422176700"}], "year"=>2017, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-85022336890", "pmid"=>"28692694", "doi"=>"10.1371/journal.pone.0178509", "pui"=>"617239345", "isbn"=>"1111111111", "sgr"=>"85022336890"}, "id"=>"5247b29e-af18-3149-a8cc-780b1838fa70", "abstract"=>"Recent data indicate AKI is very common among hospitalized Chinese patients and continuous renal replacement therapy (CRRT) is increasingly offered for treatment. However, only anecdotal information regarding CRRT's use in relation to other modalities and the specific manner in which it is prescribed exists currently. This report summarizes the results of a comprehensive physician survey designed to characterize contemporary dialytic management of AKI patients in China, especially with respect to the utilization of CRRT. The survey queried both nephrologists and critical care physicians across a wide spectrum of hospitals about factors influencing initial RRT modality selection, especially patient clinical characteristics and willingness to receive RRT, treatment location, and institutional capabilities. For patients initially treated with CRRT, data related to indication, timing of treatment initiation, dose, anticoagulation technique, and duration of therapy were also collected. Among AKI patients considered RRT candidates, the survey indicated 15.1% (95% CI, 12.3%-17.9%) did not actually receive dialysis at Chinese hospitals. The finding was largely attributed to prohibitively high therapy costs in the view of patients or their families. The survey confirmed the dichotomy in RRT delivery in China, occurring both in the nephrology department (with nephrologists responsible) and the intensive care unit (with critical care physicians responsible). For all patients who were offered and received RRT, the survey participants reported 63.9% (56.4%-71.3%) were treated initially with CRRT and 24.8% (19.2%-30.3%) with intermittent hemodialysis (HD) (P<0.001). The mean percentage of patients considered hemodynamically unstable at RRT initiation was 36.2% (31.3%-41.1%), although this figure was two-fold higher in patients treated initially with CRRT (43.1%; 35.8%-50.4%) in comparison to those initially treated with HD (22.4%; 16.4%-28.4%)(P<0.001). An overwhelming majority of intensive care patients were treated initially with CRRT (86.6%; 79.8-93.4%) while it was the initial modality in only 44.6% (33.5-55.7%) of patients treated in a nephrology department (P<0.001). Approximately 70% of respondents overall reported prescribing a CRRT dose in the range of 20-30 mL/kg/hr while approximately 20% of prescriptions fell above this range. Daily prescribed therapy duration demonstrated a marked divergence from values reported in the literature and standard clinical practice. Overall, the most common average prescribed value (50% of respondents) fell in the 10-20 hr range, with only 18% in the 20-24 hr range. Moreover, 32% of respondents reported an average prescribed value of less than 10 hrs per day. While the percentages for the 10-20 hrs range were essentially the same for nephrology and ICU programs, a daily duration of less than 10 hrs was much more common in nephrology programs (48.0%; 38.3%-57.9%) versus ICU programs (16%; 10.0%-24.6%)(P<0.001). Our analysis demonstrates both similarities and differences between RRT practices for AKI in China and those in the developed world. While some differences are driven by non-medical factors, future studies should explore these issues further as Chinese RRT practices are harmonized with those in the rest of the world.", "link"=>"http://www.mendeley.com/research/renal-replacement-therapy-practices-patients-acute-kidney-injury-china", "reader_count"=>10, "reader_count_by_academic_status"=>{"Librarian"=>1, "Researcher"=>1, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>4, "Student > Bachelor"=>1, "Unspecified"=>1}, "reader_count_by_user_role"=>{"Librarian"=>1, "Researcher"=>1, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>4, "Student > Bachelor"=>1, "Unspecified"=>1}, "reader_count_by_subject_area"=>{"Biochemistry, Genetics and Molecular Biology"=>1, "Medicine and Dentistry"=>7, "Social Sciences"=>1, "Unspecified"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>7}, "Social Sciences"=>{"Social Sciences"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>1}}, "group_count"=>1}

Scopus | Further Information

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