Document Detail


What is 'BEST' RRT practice?
MedLine Citation:
PMID:  20427975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute kidney injury (AKI) is a common complication among critical illnesses. In severe cases, renal replacement therapy (RRT) is required. It has been reported that hospital mortality of the patients who require RRT is more than 60%. Because of the high mortality, it is quite important to conduct RRT appropriately to improve outcome of patients with severe AKI. However, RRT is not a single homogeneous therapy but rather there are diverse modes of therapy and various ways of providing RRT that might affect its efficacy and safety. The Acute Dialysis Quality Initiative (ADQI) reviewed the available evidence and recommended that more research should be conducted on such technical aspects of RRT in order to determine if certain techniques are preferred for certain indications. As a response to the recommendation by ADQI, the BEST Kidney (Beginning and Ending Supportive Therapy for the Kidney) study was conducted. This study is a multicenter, multinational, prospective, epidemiological study with the aim of understanding multiple aspects of AKI at an international level. This study was conducted at 54 centers in 23 countries from September 2000 to December 2001. The study included more than 1,700 patients including 1,260 who were treated with RRT. Using the large database, several aspects related to RRT have been analyzed, including comparison of IRRT and continuous RRT (CRRT), timing of RRT initiation and discontinuation, and practice variations for CRRT around the world. This study found that RRT practice was quite varied around the world. RRT practice is not aligned with the best evidence and variations in practice may be responsible for significant morbidity. The BEST Kidney Study has generated several hypotheses related to RRT practice in the intensive care unit. Such hypotheses will need to be tested in future clinical trials and hopefully help reduce practice variations for patients with AKI requiring RRT.
Authors:
Shigehiko Uchino
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2010-04-20
Journal Detail:
Title:  Contributions to nephrology     Volume:  165     ISSN:  1662-2782     ISO Abbreviation:  Contrib Nephrol     Publication Date:  2010  
Date Detail:
Created Date:  2010-04-29     Completed Date:  2010-07-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513582     Medline TA:  Contrib Nephrol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  244-50     Citation Subset:  IM    
Copyright Information:
2010 S. Karger AG, Basel.
Affiliation:
Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan. s.uchino@jikei.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Arrhythmias, Cardiac / epidemiology,  mortality
Asia
Australia
Critical Illness
Europe
Humans
Hypotension / epidemiology
Intensive Care Units*
Kidney Failure, Acute / epidemiology,  etiology,  mortality,  therapy*
North America
Peritoneal Dialysis
Renal Replacement Therapy / adverse effects,  methods,  standards*,  statistics & numerical data
South America
Survival Rate
Treatment Outcome
World Health
Chemical
Reg. No./Substance:
0/Anticoagulants

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