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. 2017 Nov 13;18(1):332.
doi: 10.1186/s12882-017-0746-8.

The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience

Harin Rhee  1   2 , Gum Sook Jang  3 , Miyeun Han  1   2 , In Seong Park  1   2 , Il Young Kim  1 , Sang Heon Song  1   2 , Eun Young Seong  1   2 , Dong Won Lee  1 , Soo Bong Lee  1 , Ihm Soo Kwak  4   5   6
Affiliations

The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience

Harin Rhee et al. BMC Nephrol. .

Abstract

Background: The requirement of continuous renal replacement therapy (CRRT) is increasing with the growing incidence of acute kidney injury (AKI). The decision to initiate CRRT is not difficult if an adequate medical history is obtained. However, the handling and maintenance of CRRT constitute a labor-intensive intervention that requires specialized skills. For these reasons, our center organized a specialized CRRT team in March 2013. The aim of this study is to report on the role of a specialized CRRT team and to evaluate the team's outcome.

Methods: This retrospective single-center study evaluated AKI patients who underwent CRRT in the intensive care unit (ICU) from March 2011 to February 2015. Patients were divided into two groups based on whether they received specialized CRRT team intervention. We collected information on demographic characteristics, laboratory parameters, SOFA score, CRRT initiation time, actual delivered dose and CRRT down-time. In-hospital mortality was defined by medical chart review. Binary logistic regression analysis was used to define factors associated with in-hospital mortality.

Results: A total of 1104 patients were included in this study. The mean patient age was 63.85 ± 14.39 years old, and 62.8% of the patients were male. After the specialized CRRT team intervention, there was a significant reduction in CRRT initiation time (5.30 ± 13.86 vs. 3.60 ± 11.59 days, p = 0.027) and CRRT down-time (1.78 ± 2.23 vs. 1.38 ± 2.08 h/day, p = 0.002). The rate of in-hospital mortality decreased after the specialized CRRT team intervention (57.5 vs. 49.2%, p = 0.007). When the multivariable analysis was adjusted, delayed CRRT initiation (HR 1.054(1.036-1.072), p < 0.001) was a significant factor in predicting in-hospital mortality, along with an increased SOFA score, lower serum albumin and prolonged prothrombin time.

Conclusions: Our study shows that specialized CRRT team intervention reduced CRRT initiation time, down-time and in-hospital mortality. This study could serve as a logical basis for implementing specialized CRRT teams hospital-wide.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Specialized team intervention.

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Conflict of interest statement

Ethical approval and consent to participate

Approval to perform anonymous analyses of routinely collected clinical data was obtained with a waiver of informed consent from the Pusan National University IRB Committee [1702–031-051].

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Performance of the specialized CRRT team
Fig. 2
Fig. 2
Comparisons of mortality rate between pre- and post-CRRT team intervention; a) All-cause mortality rate, b) Mortality rate during the CRRT operation. * P-value <0.05
See this image and copyright information in PMC

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