Dialysis Practices and Outcomes in Critically Ill Patients in DaVita Brazil: A Multicenter Database Analysis

Background: This study describes the epidemiological characteristics, technical aspects, and outcomes of dialysis therapy in intensive care units across Brazil, using a multicenter database from DaVita Brazil from 2023 to 2025. Methods: This is a retrospective descriptive analysis of a national database comprising 89,064 ICU admissions between January 2023 and March 2025. Among these, 61,879 patients underwent dialysis. Data were recorded from multiple Brazilian centers. No inferential statistical analysis was performed. Results: A total of 700,101 dialysis sessions were performed in 61,879 patients, with a mean of 11.3 sessions per patient. Intermittent hemodialysis (HDI) was the most frequent modality, used in 74.4% of patients, followed by sustained low-efficiency dialysis (SLED, 16.5%) and continuous renal replacement therapy (CRRT, 6.8%). The most common age range among dialyzed patients was 60–80 years (45.2%). Hypertension was present in 52.8%, diabetes in 16.9%, and chronic kidney disease in 11.6%. The main reported causes of acute kidney injury were sepsis (15.2%), critical illness (15.1%), and shock (13.6%). During dialysis sessions, 47.6% of patients were receiving invasive mechanical ventilation and 87.5% were receiving norepinephrine. A total of 18,189 dialysis catheters were inserted, with 42.1% requiring replacement. The most common reasons for catheter exchange were suspected infection (33.4%) and low flow (30.4%). Ultrasonographic guidance was used in 97% of catheter insertions. Among 4,200 patients treated with CRRT, 24,662 sessions were performed. Downtime was below 10% in 82% of CRRT sessions. The average filter lifespan was 86.5 hours. Overall in-hospital mortality among patients who received dialysis was 10.8%. By modality, mortality was 7.4% in HDI, 16.5% in SLED, and 34.1% in CRRT. Mortality by age group was 15% in patients aged 45–60 years, 20% in those aged 60–80 years, and 25% in those over 80 years. Conclusion: This analysis provides a detailed characterization of dialysis practices in critically ill patients across Brazilian intensive care units from 2023 to 2025. The results reflect real-world operational and clinical patterns across a large national sample.