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Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery.
Crit Care Med. 2003 Feb; 31(2):449-55.CC

Abstract

OBJECTIVE

Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choosing the method of dialysis. As such, the objective of this study was to estimate the cost of CRRT and intermittent hemodialysis in the intensive care unit and to explore the impact of renal recovery on subsequent clinical outcomes and costs among survivors.

DESIGN

Retrospective cohort study of all patients who developed acute renal failure and required dialysis between April 1, 1996, and March 31, 1999.

SETTING

Two tertiary care intensive care units in Calgary, Canada.

PATIENTS

A total of 261 critically ill patients.

INTERVENTIONS

None.

MEASUREMENTS

All patients were followed to determine in-hospital and subsequent clinical outcomes (survival and frequency of renal recovery). The immediate and potential long-term costs of CRRT and intermittent hemodialysis were measured.

MAIN RESULTS

The cost of performing CRRT ranged from Can 3,486 dollars to Can 5,117 dollars per week, depending on the modality and the anticoagulant used, and it was significantly more expensive than intermittent hemodialysis (Can 1,342 dollars per week). Survivors with renal recovery spent significantly fewer days in hospital (11.3 vs. 22.5 days, p<.001) and incurred less healthcare costs (11,192 dollars vs. 73,273 dollars, p<.001) over the year after hospital discharge compared with survivors who remained on dialysis.

CONCLUSIONS

Immediate cost savings could be achieved by increasing the use of intermittent hemodialysis rather than CRRT for patients with acute renal failure in the intensive care unit. Because of the high cost of ongoing dialysis, CRRT may still be an economically efficient treatment if it improves renal recovery among survivors; further study in this area is required.

Authors+Show Affiliations

Department of Medicine, University of Calgary, Alberta, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12576950

Citation

Manns, Braden, et al. "Cost of Acute Renal Failure Requiring Dialysis in the Intensive Care Unit: Clinical and Resource Implications of Renal Recovery." Critical Care Medicine, vol. 31, no. 2, 2003, pp. 449-55.
Manns B, Doig CJ, Lee H, et al. Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med. 2003;31(2):449-55.
Manns, B., Doig, C. J., Lee, H., Dean, S., Tonelli, M., Johnson, D., & Donaldson, C. (2003). Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Critical Care Medicine, 31(2), 449-55.
Manns B, et al. Cost of Acute Renal Failure Requiring Dialysis in the Intensive Care Unit: Clinical and Resource Implications of Renal Recovery. Crit Care Med. 2003;31(2):449-55. PubMed PMID: 12576950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. AU - Manns,Braden, AU - Doig,Christopher James, AU - Lee,Helen, AU - Dean,Stafford, AU - Tonelli,Marcello, AU - Johnson,David, AU - Donaldson,Cam, PY - 2003/2/11/pubmed PY - 2003/3/26/medline PY - 2003/2/11/entrez SP - 449 EP - 55 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 2 N2 - OBJECTIVE: Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choosing the method of dialysis. As such, the objective of this study was to estimate the cost of CRRT and intermittent hemodialysis in the intensive care unit and to explore the impact of renal recovery on subsequent clinical outcomes and costs among survivors. DESIGN: Retrospective cohort study of all patients who developed acute renal failure and required dialysis between April 1, 1996, and March 31, 1999. SETTING: Two tertiary care intensive care units in Calgary, Canada. PATIENTS: A total of 261 critically ill patients. INTERVENTIONS: None. MEASUREMENTS: All patients were followed to determine in-hospital and subsequent clinical outcomes (survival and frequency of renal recovery). The immediate and potential long-term costs of CRRT and intermittent hemodialysis were measured. MAIN RESULTS: The cost of performing CRRT ranged from Can 3,486 dollars to Can 5,117 dollars per week, depending on the modality and the anticoagulant used, and it was significantly more expensive than intermittent hemodialysis (Can 1,342 dollars per week). Survivors with renal recovery spent significantly fewer days in hospital (11.3 vs. 22.5 days, p<.001) and incurred less healthcare costs (11,192 dollars vs. 73,273 dollars, p<.001) over the year after hospital discharge compared with survivors who remained on dialysis. CONCLUSIONS: Immediate cost savings could be achieved by increasing the use of intermittent hemodialysis rather than CRRT for patients with acute renal failure in the intensive care unit. Because of the high cost of ongoing dialysis, CRRT may still be an economically efficient treatment if it improves renal recovery among survivors; further study in this area is required. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12576950/Cost_of_acute_renal_failure_requiring_dialysis_in_the_intensive_care_unit:_clinical_and_resource_implications_of_renal_recovery_ L2 - https://dx.doi.org/10.1097/01.CCM.0000045182.90302.B3 DB - PRIME DP - Unbound Medicine ER -