The effect of specialized continuous renal replacement therapy team in acute kidney injury patients treatment

Abstract

Purpose: Continuous renal replacement therapy (CRRT) has been established for critically ill acute kidney injury (AKI) patients. In addition, some centers consist of a specialized CRRT team (SCT) with physicians and nurses. To our best knowledge, however, ona a few studies have yet been carried out on the superiority of SCT management.

Materials and methods: A total of 551 patients, who received CRRT between January 2008 and March 2009, were divided into two groups based on the controller of CRRT. The impact of the CRRT management on 28-day mortality was compared between two groups by Kaplan-Meier curve and Cox analysis.

Results: During the study period, the number of filters used, down-time per day, and intensive care unit length of day were significantly higher in non-SCT group than in SCT group (6.2 hrs vs. 5.0 hrs, p=0.042; 5.0 hrs vs. 3.8 hrs, p<0.001; 27.5 days vs. 21.1 days, p=0.027, respectively), while net ultrafiltration rate was significantly lower in non-SCT group than SCT group (28.0 mL/kg/hr vs. 29.5 mL/kg/hr, p=0.043, respectively). In addition, 28-day mortality rate was significantly lower in SCT group than with non-SCT group (p=0.031). Moreover, Cox regression analysis showed that 28-day mortality rate was significantly lower in SCT control group, even after adjusting for age, gender, severity scores, biomarkers, risk, injury, failure, loss, and end-stage renal disease, and contributing factors (hazard ratio 0.91, p=0.046).

Conclusion: A well-trained CRRT team could be beneficial for mortality improvement of AKI patients requiring CRRT.

Keywords: 28-day mortality; SCT management; acute kidney injury; continuous renal replacement therapy.

Fig. 1. Flow diagram of patient selection and outcomes. A total of 640 ICU patients who received CRRT for severe AKI between August 2007 and September 2009 were initially analyzed. We excluded 89 patients because they died within the first 24 hours of CRRT, were less than 18 years of age, were on chronic dialysis, or were diagnosed with terminal malignancy which was considering less than 3 month-life expectancy. In the final analysis, 551 patients were enrolled and investigated. ICU, intensive care; CRRT, continuous renal replacement therapy; AKI, acute kidney injury; non-SCT, conventional team approach; SCT, specialized CRRT team.

Fig. 2. Kaplan-Meier plots for cumulative 28-day mortality. 28-day all-cause mortality rates after the SCT approach were significantly reduced (log rank p=0.016). non-SCT, conventional team approach; SCT, specialized continuous renal replacement therapy team.