IMPORTANCE: Continuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs. OBJECTIVE: To describe current CKRT practices across European PICUs. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022. MAIN OUTCOME AND MEASURES: Demographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed. RESULTS: Of 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%). CONCLUSIONS AND RELEVANCE: This survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.

Children's Acute Transport Service Great Ormond Street Hospital for Children National Health Service Foundation Trust London United Kingdom

Department of Cardiothoracic Surgery Centre Hospitalier Universitaire of Martinique Fort de France Martinique

Department of General Pediatrics University Children's Hospital Muenster Muenster Germany

Department of Pediatric Intensive Care Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht the Netherlands

Department of Pediatrics Medical University of Innsbruck Innsbruck Austria

Department of Women and Children's Health School of Life Course Sciences King's College London London United Kingdom

Division of Neonatal and Pediatric Intensive Care Department of Pediatrics Gynecology and Obstetrics Children's Hospital Geneva University Hospitals and Faculty of Medicine Geneva Switzerland

Institute for Child and Youth Health Care of Vojvodina Medical Faculty University of Novi Sad Novi Sad Serbia

Paediatric Intensive Care Unit King's College Hospital NHS Foundation Trust Denmark Hill London United Kingdom

Pediatric Intensive Care Medicine Istanbul Faculty of Medicine Istanbul Turkey

Pediatric Intensive Care Unit Department of Pediatrics University Hospital of Ostrava Faculty of Medicine Ostrava Ostrava Czech Republic

Pediatric Intensive Care Unit Department of Woman's and Child's Health University Hospital of Padua Padua Italy

Pediatric Intensive Care Unit Meyer Children's Hospital Florence Italy

Pediatric Intensive Care Unit Pediatric Department Hospital de Santa Maria North Lisbon University Hospital Center Lisbon Portugal

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JAMA Netw Open. 2022 Dec 1;5(12):e2246909. doi: 10.1001/jamanetworkopen.2022.46909. PubMed

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