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Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial

  • Benichou, Nicolas1, 2, 3
  • Lebbah, Saïd4
  • Hajage, David4, 5, 6
  • Martin-Lefèvre, Laurent7
  • Pons, Bertrand8
  • Boulet, Eric9
  • Boyer, Alexandre10
  • Chevrel, Guillaume11
  • Lerolle, Nicolas12
  • Carpentier, Dorothée13
  • de Prost, Nicolas14, 15
  • Lautrette, Alexandre16
  • Bretagnol, Anne17
  • Mayaux, Julien18
  • Nseir, Saad19
  • Megarbane, Bruno20
  • Thirion, Marina21
  • Forel, Jean-Marie22
  • Maizel, Julien23
  • Yonis, Hodane24
  • And 7 more
  • 1 AP-HP, Hôpital Européen Georges Pompidou, Service de Néphrologie, Paris, 75015, France , Paris (France)
  • 2 Université de Paris, Paris, France , Paris (France)
  • 3 French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, Paris, 75020, France , Paris (France)
  • 4 AP-HP, Hôpital Pitié-Salpêtrière, Paris, 75013, France , Paris (France)
  • 5 INSERM, ECEVE, U1123, CIC 1421, Paris, F-75013, France , Paris (France)
  • 6 Sorbonne Université, Université, Paris, France , Paris (France)
  • 7 Réanimation Médico-Chirurgicale, CHG, La Roche-sur-Yon, France , La Roche-sur-Yon (France)
  • 8 CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France , Pointe-à-Pitre (France)
  • 9 Réanimation Polyvalente, CH René Dubos, Pontoise, 95301, France , Pontoise (France)
  • 10 Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux, 33000, France , Bordeaux (France)
  • 11 Centre Hospitalier Sud Francilien, Corbeil Essonne, France , Corbeil Essonne (France)
  • 12 CHU Angers, Université D’Angers, Angers, France , Angers (France)
  • 13 Réanimation Médicale, CHU Rouen, Rouen, 76000, France , Rouen (France)
  • 14 Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France , Créteil (France)
  • 15 CARMAS Research Group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France , Créteil (France)
  • 16 Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France , Clermont-Ferrand (France)
  • 17 Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional D’Orléans, BP 6709, Orléans Cedex, 45067, France , Orléans Cedex (France)
  • 18 APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France , Paris (France)
  • 19 Université de Lille, Lille, 59000, France , Lille (France)
  • 20 Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France , Paris (France)
  • 21 Réanimation Polyvalente, CH Victor Dupouy, Argenteuil Cedex, 95107, France , Argenteuil Cedex (France)
  • 22 Hôpital Nord Marseille, Marseille, 13015, France , Marseille (France)
  • 23 Service de Réanimation Médicale INSERM U1088, Centre Hospitalier Universitaire de Picardie, Amiens, France , Amiens (France)
  • 24 Réanimation Médicale, Hôpital de La Croix Rousse, Lyon, 69004, France , Lyon (France)
  • 25 Réanimation, CH Cholet, Cholet, 49300, France , Cholet (France)
  • 26 Centre Hospitalier Inter-Communal, Service de Réanimation Polyvalente Adulte, Créteil, France , Créteil (France)
  • 27 Univ Pierre Et Marie Curie, Sorbonne Universités, Paris, 75013, France , Paris (France)
  • 28 Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, Paris, 75018, France , Paris (France)
  • 29 AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, 92700, France , Colombes (France)
  • 30 AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Bobigny, 93008, France , Bobigny (France)
  • 31 Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Rue de Stalingrad, Bobigny, 93000, France , Bobigny (France)
Published Article
Annals of Intensive Care
Springer (Biomed Central Ltd.)
Publication Date
Apr 08, 2021
DOI: 10.1186/s13613-021-00843-3
Springer Nature


BackgroundVascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury.Patients and methodsWe performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected.ResultsAmong the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34–4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98–1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64—1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred.ConclusionFemoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.

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