title: Clinical and economic impact of a switch from high- to low-volume renal replacement therapy in patients with acute kidney injury.
abstract: High-intensity renal replacement therapy protocols in intensive care patients with acute kidney injury have failed to translate to improved patient outcomes when compared with lower-intensity protocols. This retrospective study explored the clinical and economic impacts of switching from a 30-35 ml.kg(-1) .h(-1) (high-volume) to a 20 ml.kg(-1) .h(-1) (low-volume) protocol. Patients (n = 366) admitted 12 months before (n = 187) and after (n = 179) the switch were included in the study. There was no difference in in-hospital mortality (77/187 (41%) vs 75/179 (42%), respectively, p = 0.92), intensive care unit mortality (55/187 (29%) vs 61/179 (34%), respectively, p = 0.40), duration of organ support or extent of renal recovery between the high- and low-volume cohorts. A 25% reduction in daily replacement fluid usage was observed, equating to a cost saving of over £27 000 per annum. In conclusion, a switch from high- to low-volume continuous haemodiafiltration had minimal effects on clinical outcomes and resulted in marked cost savings.
authors.affiliation: Addenbrooke's Hospital, Cambridge, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Paterson
authors.forename: A J
authors.initials: AJ
authors.lastname: Johnston
authors.forename: D
authors.initials: D
authors.lastname: Kingston
authors.forename: R
authors.initials: R
authors.lastname: Mahroof
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017046:Cost Savings; D003422:Critical Care; D005260:Female; D017583:Hemodiafiltration / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007677:Kidney Function Tests; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D017582:Renal Replacement Therapy / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult