Sustained low efficiency dialysis as standard renal replacement therapy in an interdisciplinary intensive care unit-Afive year cost-benefit analysis
Keywords:
Acute Kidney Injury, Dyalisis, Efficiency, Intensive Care, Renal Replacement Therapy
Abstract
Background: Sustained low efficiency dialysis (SLED) as primary renal replacement therapy (RRT) in acute kidney injury (AKI) is not widely used, despite substantial economical advantages. We evaluated costs and outcome ina5year retrospective study on our ICU. Methods:From 2006 to 2010 we selected all patients with the ICD-10 codes N17 and N18 who were treated with SLED on our ICU. Patients with a stay <2 days, an extra-renal indication for dialysis or chronic dialysis were excluded. Variables: number of SLEDs, duration of ICU and hospital stay, ICU and hospital mortality, SAPS II, TISS 28, blood urea and creatinine, C-reactive protein, mechanical ventilation, diagnoses. Long-term outcome was evaluated by sending all discharged patients a questionnaire.
Results: Between 2006 and 2010, 3247 SLED-treatments in 421 patients (mean SAPS II: 41 points without GCS) were performed. ICU and hospital mortality in the patients treated only with SLED (n = 392) was 34% and 45%, respectively. 71% of all surviving patients had good quality of life and 12% of all discharged patients still needed dialysis. Total costs for SLED were 526.819D and total proceeds were 734.996D .Assuming also 3247 "CVVHDF-days" for cost comparisons we calculated costs of 722.750D with proceeds of690.864D for CVVHDF.
Conclusions: In critically ill patients with AKI SLED is an effective RRT, with short- and long-term outcome being comparable to outcome data with CVVHDF. Based on our cost-proceeds analysis SLED seems to be the preferable renal replacement therapy.
References
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26.Korkeila M, Ruokonen E, Takala J. Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med. 2000;26:1824-31.
27.Triverio PA, Martin PY, Romand J, Pugin J, Perneger T, Saudan P. Long-term prognosis after acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant. 2009;24:2186-9.
28.Marshall MR, Golper TA, Shaver MJ, Alam MG, Chatoth DK. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int. 2001;60:777-85.
29.Kumar VA, Craig M, Depner TA, Yeun JY. Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis. 2000;36:294-300.
30.Vanholder R, Van Biesen W, Hoste E, Lameire N. Pro/con debate: continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish? Crit Care. 2011;15:204.
31. Zhang Z, Honqying N. Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy. Intensive Care Med. 2012;38:20-8.
2.Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically patients. Nephrol Dial Transplant. 2008;23: 1203-10.
3.Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34:1913-7.
4.Oppert M, Engel C, Brunkhorst FM, Bogatsch H, Reinhart K, Frei U, Eckardt KU, et al. Acute renal failure in patients with severe sepsis and septic shock - a significant independent risk factor for mortality: results from the German Prevalence Study. Nephrol Dial Transplant. 2008;23: 904-9.
5.Liano F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl. 1998;66: 16-24.
6.Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813-8.
7.Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30:2051-8.
8.Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomized trial. Lancet. 2006;368:379-85.
9.VA/NIH Acute Renal Failure Trial NetworkPalevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359: 7-20.
10. RENAL Replacement Therapy Study InvestigatorsBellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627-38.
11.Srisawat N, Lawsin L, Uchino S, Bellomo R, Kellum JA, BEST Kidney Investigators. Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study. Crit Care. 2010;14:R46.
12.Rauf AA, Long KH, Gajic O, Anderson SS, Swaminathan L, Albright RC. Intermittent hemodialysis versus continuous renal replacement therapy for acute renal failure in the intensive care unit: an observational outcomes analysis. J Intensive Care Med. 2008;23:195-203.
13.Berbece AN, Richardson RM. Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal. Kidney Int. 2006;70:963-8.
14.Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1:480-4.
15.Fliser D, Kielstein JT. A single-pass batch dialysis system: an ideal dialysis method for the patient in intensive care with acute renal failure. Curr Opin Crit Care. 2004;10: 483-8.
16.Neuenfeldt T, Hopf HB. Successful treatment of extreme metabolic acidosis and profound hypothermia. Anaesthesist. 2009;58:1113-8.
17.Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure -definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8: R204-12.
18.Druml W. Acute renal failure is not a "cute" renal failure! Intensive Care Med. 2004;30:1886-90.
19.Woodrow G, Turney JH. Cause of death in acute renal failure. Nephrol Dial Transplant. 1992;7:230-4.
20.Gettings LG, Reynolds HN, Scalea T. Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs. late. Intensive Care Med. 1999;25:805-13.
21.Elahi MM, Lim MY, Joseph RN, Dhannapuneni RR, Spyt TJ. Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure. Eur J Cardiothorac Surg. 2004;26:1027-31.
22.Morgera S, Kraft AK, Siebert G, Luft FC, Neumayer HH. Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis. 2002;40:275-9.
23.Ahlstrom A, Tallgren M, Peltonen S, Rásánen P, Pettilá V. Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med. 2005;31: 1222-8.
24.Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care. 2005;9:R700-9.
25.Schiffl H, Fischer R. Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant. 2008;23:2235-41.
26.Korkeila M, Ruokonen E, Takala J. Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med. 2000;26:1824-31.
27.Triverio PA, Martin PY, Romand J, Pugin J, Perneger T, Saudan P. Long-term prognosis after acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant. 2009;24:2186-9.
28.Marshall MR, Golper TA, Shaver MJ, Alam MG, Chatoth DK. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int. 2001;60:777-85.
29.Kumar VA, Craig M, Depner TA, Yeun JY. Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis. 2000;36:294-300.
30.Vanholder R, Van Biesen W, Hoste E, Lameire N. Pro/con debate: continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish? Crit Care. 2011;15:204.
31. Zhang Z, Honqying N. Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy. Intensive Care Med. 2012;38:20-8.
How to Cite
1.
Neuenfeldt T, Hopf H-B. Sustained low efficiency dialysis as standard renal replacement therapy in an interdisciplinary intensive care unit-Afive year cost-benefit analysis. Colomb. J. Anesthesiol. [Internet]. 2013 Apr. 1 [cited 2024 Apr. 26];41(2):88-96. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/793
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2013-04-01
How to Cite
1.
Neuenfeldt T, Hopf H-B. Sustained low efficiency dialysis as standard renal replacement therapy in an interdisciplinary intensive care unit-Afive year cost-benefit analysis. Colomb. J. Anesthesiol. [Internet]. 2013 Apr. 1 [cited 2024 Apr. 26];41(2):88-96. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/793
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