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Continuous renal replacement therapy (CRRT) is frequently used among hemodynamically unstable critically ill patients with acute renal failure (ARF). However, data regarding management of these patients in Serbia are scarce. CRRT has been available at our institution since 2007. The objective of this study was to describe characteristics and outcome of patients treated with renal replacement therapy in a single tertiary-care center in Serbia.
In this retrospective observational study we reviewed medical records of adult (≥18 years) patients treated in the five-bed ICU at the Institute for Pulmonary Diseases in Sremska Kamenica, Serbia who underwent CRRT from April 2007 to November 2009.
From the total 314 patients treated in the ICU, 29 (9.2%), 17 men, median age 54 years (interquartile range (IQR) 48 to 68), underwent CRRT. Patients were mostly nonsurgical (n = 28, 96%). Main admission diagnoses were septic shock (n = 11) and pneumonia (n = 9). The median APACHE II score was 27 (IQR 19 to 32), and SOFA day 1 was 10 (IQR 5 to 13). Seventeen patients (58.6%) had chronic co-morbidities; Charlson score median 2 (IQR 0.75 to 3). Twenty-four patients required mechanical ventilation, and 13 were diagnosed with acute respiratory distress syndrome. Slow continuous ultrafiltration was used in four patients (13.7%), hemodiafiltration (CVVHDF) modality in 13 (44.8%), hemodialysis (CVVHD) in 11 (37.9%). Median time on CRRT was 3 days (IQR 2 to 4). Five patients (17%) had a complete recovery of renal function at the time of ICU discharge. Median hospital length of stay was 12 days (IQR 5 to 20) and hospital mortality was 69%.
The need for CRRT in the observed population is substantial. Future studies are warranted to determine the impact of introduction of CRRT on hospital mortality in Eastern European countries and to provide future strategies for improving patient care in these settings.