Questionnaire survey on the prescription of renal replacement therapy for acute phase patients on maintenance dialysis w
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ORIGINAL ARTICLE
Questionnaire survey on the prescription of renal replacement therapy for acute phase patients on maintenance dialysis who developed cerebrovascular disease Maho Akiu1,2 · Tae Yamamoto1,3 · Emi Fujikura1,2 · Koji Okamoto1 · Atsuhiro Nakagawa4 · Mai Yoshida1 · Takashi Nakamichi1,5 · Taro Fukushi1 · Tasuku Nagasawa1 · Yuji Oe1 · Masaaki Nakayama6,7 · Hiroshi Sato1,8 · Teiji Tominaga4 · Sadayoshi Ito1,9 · Hideo Harigae1,10 · Mariko Miyazaki1,2 Received: 4 February 2020 / Accepted: 12 May 2020 © Japanese Society of Nephrology 2020
Abstract Background There is limited information about acute phase renal replacement therapy (RRT) for maintenance hemodialysis patients after the onset of cerebrovascular disease. This study aimed to investigate which modality of renal replacement therapy is currently selected in practice. Methods We conducted a mail-based survey in 317 dialysis facilities that were certified by three academic societies that focus on dialysis, neurology, and neurosurgery in Japan. Results We received responses from 103 facilities (32.5%). In cases of cerebral infarction (CI) and intracerebral hemorrhage (ICH), more than 80% of the facilities selected only intermittent RRT, and 22.3% (CI)/8.7% (ICH) of the facilities selected intermittent HD which is the same setting in normal conditions. Although continuous hemodiafiltration and peritoneal dialysis are recommended in the Japanese guidelines, these were selected in only a few facilities: 16.5% and 0% in CI, 16.5% and 1% in ICH, respectively. RRT on the day of onset tended to be avoided, irrespective of the duration following the last HD session. Furthermore, physicians preferred to modify anticoagulants and reduce dialysis performance in the acute phase. Conclusion This questionnaire survey uncovered a gap between guidelines and actual practice, even in hospitals accredited as educational facility, which is a novel and important finding. Further studies with larger sample sizes are needed to determine the optimal modality of RRT for the acute phase of cerebrovascular disease. Keywords Cerebrovascular disease · Continuous renal replacement therapy · Maintenance hemodialysis · Questionnaire · Stroke
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10157-020-01905-9) contains supplementary material, which is available to authorized users. * Mariko Miyazaki [email protected] 1
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Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan Division of Blood Purification, Tohoku University Hospital, Sendai, Japan Division of Internal Medicine, Sendai City Hospital, Sendai, Japan Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Division of Nephrology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
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Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, Sendai, Japan
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Division of Nephrology, St
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