title: Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review.
abstract: OBJECTIVE
  Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients.
  
  
  METHODS
  A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected, and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle-Ottawa Scale (NOS) and Cochrane risk of bias tool. Data were summarized narratively.
  
  
  RESULTS
  Our search yielded 8374 citations, of which 133 fulfilled eligibility. This included 97 cohort studies, 24 randomized controlled trials, 10 case-control studies, and 2 retrospective medical audits. The quality of retrieved studies was generally good. In total, 18 QIs were identified that were mentioned in 238 instances. Identified QIs were classified as related to structure (n = 4, 22.2 %), care processes (n = 9, 50.0 %), and outcomes (n = 5, 27.8 %). The most commonly mentioned QIs focused on filter lifespan (n = 98), small solute clearance (n = 46), bleeding (n = 30), delivered dose (n = 19), and treatment interruption (n = 5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n = 144, 48.3 %), scientifically acceptable (n = 32, 10.7 %), and useable and/or feasible (n = 17, 5.7 %) by their primary study authors.
  
  
  CONCLUSIONS
  We identified numerous potential QIs of CRRT care, characterized by heterogeneous definitions, varying quality of derivation, and limited evaluation. Further study is needed to prioritize a concise inventory of QIs to measure, improve, and benchmark CRRT care for critically ill patients.
  
  
  BACKGROUND
  PROSPERO CRD42015015530.
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada. rewa@ualberta.ca.
authors.forename: Oleksa G
authors.initials: OG
authors.lastname: Rewa
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
authors.forename: Pierre-Marc
authors.initials: PM
authors.lastname: Villeneuve
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lachance
authors.affiliation: 2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
authors.affiliation: Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
authors.forename: R T Noel
authors.initials: RTN
authors.lastname: Gibney
authors.affiliation: Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 4-486D Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.affiliation: Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 4-486D Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: Featherstone
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D016022:Case-Control Studies; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000592:standards*; D017582:Renal Replacement Therapy / Q000592:standards*; D012189:Retrospective Studies
keywords: Continuous renal replacement therapy; Critical care; Dialysis; Effectiveness; Intensive care; Quality indicator