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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 May-Jun; 23(3):195-203.JI

Abstract

BACKGROUND

Studies have failed to show a survival difference between intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). Comparative cost analyses are limited and fail to control for differences in patient disease severity and comorbid conditions. The authors retrospectively estimated clinical and economic outcomes associated with CRRT and IHD among critically ill patients experiencing acute renal failure (ARF) in 2 tertiary care hospitals in Rochester, Minnesota, between January 1, 2000, and December 12, 2001.

METHODS

161 critically ill patients requiring dialysis for ARF were analyzed. Patient demographics, comorbid conditions, ARF etiology, mode of renal replacement therapy (RRT), renal recovery, and survival were abstracted from medical chart. APACHE II scores at dialysis initiation were calculated. Administrative data tracked length of stay (LOS) and direct medical costs from initiation of RRT to death or intensive care unit (ICU) and hospital discharge. Multivariate modeling was used to adjust outcomes for baseline differences.

RESULTS

84 (52%) of the patients received CRRT and 77 (48%) received IHD. CRRT-treated patients were younger (58 vs 65 years), less likely male (58% vs 77%), had higher APACHE II scores (32 vs 27) with a higher incidence of sepsis (46% vs 30%) and respiratory disease (56% vs 39%), and were less likely to have chronic renal insufficiency (32% vs 49%). With adjustment for differences in baseline patient characteristics, the RRT method did not affect the likelihood of renal recovery, in-hospital survival, or survival during follow-up. Mean adjusted ICU LOS was 9.5 days shorter for IHD-treated than CRRT-treated patients (P< .001), and the adjusted mean difference in hospital and total costs associated with ICU stay was $56,564 and $60 827, in favor of IHD (P< .001). Mean adjusted total costs through hospital discharge were $93 611 and $140,733 among IHD-treated and CRRT-treated patients, respectively (P< .001).

CONCLUSIONS

This observational study suggests that costs may significantly differ by mode of RRT despite similar severity-adjusted patient outcomes. Future prospective comparisons of renal replacement modalities will need to include both clinical and economic outcomes.

Authors+Show Affiliations

Departments of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. anisrauf@att.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

18474503

Citation

Rauf, Anis Abdul, et al. "Intermittent Hemodialysis Versus Continuous Renal Replacement Therapy for Acute Renal Failure in the Intensive Care Unit: an Observational Outcomes Analysis." Journal of Intensive Care Medicine, vol. 23, no. 3, 2008, pp. 195-203.
Rauf AA, Long KH, Gajic O, et al. 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(3):195-203.
Rauf, A. A., Long, K. H., Gajic, O., Anderson, S. S., Swaminathan, L., & Albright, R. C. (2008). Intermittent hemodialysis versus continuous renal replacement therapy for acute renal failure in the intensive care unit: an observational outcomes analysis. Journal of Intensive Care Medicine, 23(3), 195-203. https://doi.org/10.1177/0885066608315743
Rauf AA, et al. 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 May-Jun;23(3):195-203. PubMed PMID: 18474503.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermittent hemodialysis versus continuous renal replacement therapy for acute renal failure in the intensive care unit: an observational outcomes analysis. AU - Rauf,Anis Abdul, AU - Long,Kirsten Hall, AU - Gajic,Ognjen, AU - Anderson,Stephanie S, AU - Swaminathan,Lalithapriya, AU - Albright,Robert C, PY - 2008/5/14/pubmed PY - 2008/9/18/medline PY - 2008/5/14/entrez SP - 195 EP - 203 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 23 IS - 3 N2 - BACKGROUND: Studies have failed to show a survival difference between intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). Comparative cost analyses are limited and fail to control for differences in patient disease severity and comorbid conditions. The authors retrospectively estimated clinical and economic outcomes associated with CRRT and IHD among critically ill patients experiencing acute renal failure (ARF) in 2 tertiary care hospitals in Rochester, Minnesota, between January 1, 2000, and December 12, 2001. METHODS: 161 critically ill patients requiring dialysis for ARF were analyzed. Patient demographics, comorbid conditions, ARF etiology, mode of renal replacement therapy (RRT), renal recovery, and survival were abstracted from medical chart. APACHE II scores at dialysis initiation were calculated. Administrative data tracked length of stay (LOS) and direct medical costs from initiation of RRT to death or intensive care unit (ICU) and hospital discharge. Multivariate modeling was used to adjust outcomes for baseline differences. RESULTS: 84 (52%) of the patients received CRRT and 77 (48%) received IHD. CRRT-treated patients were younger (58 vs 65 years), less likely male (58% vs 77%), had higher APACHE II scores (32 vs 27) with a higher incidence of sepsis (46% vs 30%) and respiratory disease (56% vs 39%), and were less likely to have chronic renal insufficiency (32% vs 49%). With adjustment for differences in baseline patient characteristics, the RRT method did not affect the likelihood of renal recovery, in-hospital survival, or survival during follow-up. Mean adjusted ICU LOS was 9.5 days shorter for IHD-treated than CRRT-treated patients (P< .001), and the adjusted mean difference in hospital and total costs associated with ICU stay was $56,564 and $60 827, in favor of IHD (P< .001). Mean adjusted total costs through hospital discharge were $93 611 and $140,733 among IHD-treated and CRRT-treated patients, respectively (P< .001). CONCLUSIONS: This observational study suggests that costs may significantly differ by mode of RRT despite similar severity-adjusted patient outcomes. Future prospective comparisons of renal replacement modalities will need to include both clinical and economic outcomes. SN - 0885-0666 UR - https://www.unboundmedicine.com/medline/citation/18474503/Intermittent_hemodialysis_versus_continuous_renal_replacement_therapy_for_acute_renal_failure_in_the_intensive_care_unit:_an_observational_outcomes_analysis_ L2 - https://journals.sagepub.com/doi/10.1177/0885066608315743?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -