Current worldwide practice of dialysis dose prescription in acute renal failure

Ronco, Claudio; Ricci, Zaccaria; Bellomo, Rinaldo

doi:10.1097/01.ccx.0000247447.17124.05

Cited by 15 publications

(5 citation statements)

References 18 publications

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“…Despite decades of study, the optimal dose of RRT is not known. Several recent studies investigating the optimal timing of initiation resulted in discordant findings (although the studies were significantly different in design [30–32]. In addition, many variables assumed to be associated with outcomes have been studied in some fashion or are currently actively being studied (Fig.…”

Section: Discussionmentioning

confidence: 99%

Process based quality improvement using a continuous renal replacement therapy dashboard

Goldstein

Basu

2019

BMC Nephrol

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BackgroundThe prevalence of continuous renal replacement therapy (CRRT) utilization in critically ill patients with acute kidney is increasing. In comparison to published and on-going trials attempting to answer questions surrounding the optimal timing of CRRT initiation, anticoagulation, and modality, a paucity of literature describes the quality of the therapy delivered.MethodsWe conducted a single-center process improvement project to determine if a methodology to assess the quality of CRRT delivery could lead to improvement in CRRT delivery outcomes. We developed three broad categories of objective CRRT metrics to assess longitudinally, enabling creation of a CRRT Dashboard. Following the objective categories of “filter”, “prescription”, and “fluid balance” over time allowed us to perform quarterly analyses, target provider based CRRT education, and address variation from our standard of care. From 2012 to 2017, 184 critically ill patients received CRRT.ResultsWe report a mean filter life of 56 + 28.4 h, a 60-h filter life of 62%, and unplanned filter changes of 15%. Compared to a minimum target prescription of 2000 ml/1.73 m2/hour, we report the mean prescribed dose (2300 ml/1.73 m2/hour) and the rate of patients receiving at least the minimum prescription (98%). Finally, using a 10% deviation in the acceptable range of desired daily patient fluid balance, we report 83% CRRT patient days achieving an acceptable stipulated fluid goal.ConclusionWe report the implementation of a quality dashboard and adopting quality improvement strategies provided a platform for measuring adherence to our institutional standards and the delivery of CRRT, specifically on the process of the care.

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Section: Discussionmentioning

confidence: 99%

Process based quality improvement using a continuous renal replacement therapy dashboard

Goldstein

Basu

2019

BMC Nephrol

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“…Many patients are not prescribed a dose in line with current guidelines. [8][9][10] This is because the relationship between pump rates and clearances is complex. Prescribing practice varies widely.…”

Section: Introductionmentioning

confidence: 99%

Prescribing Continuous Renal Replacement Therapy Using a JavaScript Calculator Improves Delivered Dose

Banks¹

2011

Journal of the Intensive Care Society

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“…The optimal intensity of renal replacement therapy (RRT) in acute kidney injury (AKI) remains controversial [1-4]. We recently published the results of the US Department of Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network (ATN) Study, which examined the effect of two strategies for the management of RRT on outcomes in critically ill patients with AKI [5].…”

Section: Introductionmentioning

confidence: 99%

Intensity of renal replacement therapy in acute kidney injury: perspective from within the Acute Renal Failure Trial Network Study

et al. 2009

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Determination of the optimal dose of renal replacement therapy in critically ill patients with acute kidney injury has been controversial. Questions have recently been raised regarding the design and execution of the US Department of Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network (ATN) Study, which demonstrated no improvement in 60-day all-cause mortality with more intensive management of renal replacement therapy. In the present article we present our rationale for these aspects of the design and conduct of the study, including our use of both intermittent and continuous modalities of renal support, our approach to initiation of study therapy and the volume management during study therapy. In addition, the article presents data on hypotension during therapy and recovery of kidney function in the perspective of other studies of renal support in acute kidney injury. Finally, we address the implications of the ATN Study results for clinical practice from the perspective of the study investigators.

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Current worldwide practice of dialysis dose prescription in acute renal failure

Abstract: The analysis of the epidemiology of dialysis dose around the world shows a complex picture. Wide variations in practice are present although a significant effort has been made to standardize the prescription and delivery of therapy.

Cited by 15 publications

References 18 publications

Process based quality improvement using a continuous renal replacement therapy dashboard

Process based quality improvement using a continuous renal replacement therapy dashboard

Prescribing Continuous Renal Replacement Therapy Using a JavaScript Calculator Improves Delivered Dose

Intensity of renal replacement therapy in acute kidney injury: perspective from within the Acute Renal Failure Trial Network Study

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