title: Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery.
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.
  
  
  METHODS
  Retrospective cohort study of all patients who developed acute renal failure and required dialysis between April 1, 1996, and March 31, 1999.
  
  
  METHODS
  Two tertiary care intensive care units in Calgary, Canada.
  
  
  METHODS
  A total of 261 critically ill patients.
  
  
  METHODS
  None.
  
  
  METHODS
  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.
  
  
  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.affiliation: Department of Medicine, University of Calgary, Alberta, Canada.
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: Doig
authors.forename: Helen
authors.initials: H
authors.lastname: Lee
authors.forename: Stafford
authors.initials: S
authors.lastname: Dean
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics* / Q000628:therapy*; D000416:Alberta; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics*; D012189:Retrospective Studies