Wei-Zhen Hong1,2, Sabrina Haroon1,2, Titus Lau1,2, Soh-Heng Hui1,3, Valerie Ma1,2, Jing-Xian Goh1,3, Horng-Ruey Chua4,5. 1. Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore. 2. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore. 3. Department of Nursing, National University Hospital, Singapore, Singapore. 4. Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore. horng_ruey_chua@nuhs.edu.sg. 5. Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore. horng_ruey_chua@nuhs.edu.sg.
Abstract
BACKGROUND: Patients with acute kidney injury needing prolonged renal replacement therapy (AKI-RRT) may benefit from a structured care process in form of an AKI transitional care program (ATCP), to facilitate RRT weaning and recovery. METHODS: We examined outcomes following ATCP implementation in adults with AKI-RRT from a tertiary institution (versus pre-ATCP controls), including mortality, cumulative hospital days, and renal function over one year; RRT and haemodialysis catheter days in initial 90 days. RESULTS: We studied 89 patients with age 62 ( ± 15) years. 47% had septic AKI, 20% cardiorenal syndrome, and 29% had baseline eGFR < 30 mL/min/1.73 m2. Comparing 45 ATCP patients with 44 controls: 64% and 45% received continuous RRT (CRRT) (p = 0.07), with comparable rates of heart failure (24% versus 25%), ICU care (67% versus 70%), RRT successfully weaned (71% versus 75%), respectively; corresponding mortality rates were 24% and 32% (p = 0.44), hospital days of 205 (197-213) and 223 (215-232) per 1000 patient-days alive over one year (p = 0.002); with comparable RRT and catheter days. Serial serum creatinine in months following RRT cessation were comparable between either survivor-group. On multivariate analysis, heart failure or having received CRRT independently predicted mortality and longer hospital days (p < 0.05); ATCP was independently associated with reduced hospital days (p < 0.001). 17 ATCP patients and 14 controls required outpatient RRT weaning, with catheter days of 607 (568-648) and 683 (638-731) per 1000 patient-days in initial 90 days, respectively (p = 0.01). CONCLUSIONS: Implementing a structured care pathway in patients with AKI-RRT may help reduce hospitalization, and reduce haemodialysis catheter days in the subgroup for outpatient RRT weaning.
BACKGROUND:Patients with acute kidney injury needing prolonged renal replacement therapy (AKI-RRT) may benefit from a structured care process in form of an AKI transitional care program (ATCP), to facilitate RRT weaning and recovery. METHODS: We examined outcomes following ATCP implementation in adults with AKI-RRT from a tertiary institution (versus pre-ATCP controls), including mortality, cumulative hospital days, and renal function over one year; RRT and haemodialysis catheter days in initial 90 days. RESULTS: We studied 89 patients with age 62 ( ± 15) years. 47% had septic AKI, 20% cardiorenal syndrome, and 29% had baseline eGFR < 30 mL/min/1.73 m2. Comparing 45 ATCP patients with 44 controls: 64% and 45% received continuous RRT (CRRT) (p = 0.07), with comparable rates of heart failure (24% versus 25%), ICU care (67% versus 70%), RRT successfully weaned (71% versus 75%), respectively; corresponding mortality rates were 24% and 32% (p = 0.44), hospital days of 205 (197-213) and 223 (215-232) per 1000 patient-days alive over one year (p = 0.002); with comparable RRT and catheter days. Serial serum creatinine in months following RRT cessation were comparable between either survivor-group. On multivariate analysis, heart failure or having received CRRT independently predicted mortality and longer hospital days (p < 0.05); ATCP was independently associated with reduced hospital days (p < 0.001). 17 ATCP patients and 14 controls required outpatient RRT weaning, with catheter days of 607 (568-648) and 683 (638-731) per 1000 patient-days in initial 90 days, respectively (p = 0.01). CONCLUSIONS: Implementing a structured care pathway in patients with AKI-RRT may help reduce hospitalization, and reduce haemodialysis catheter days in the subgroup for outpatient RRT weaning.
Authors: Rinaldo Bellomo; Alan Cass; Louise Cole; Simon Finfer; Martin Gallagher; Serigne Lo; Colin McArthur; Shay McGuinness; John Myburgh; Robyn Norton; Carlos Scheinkestel; Steve Su Journal: N Engl J Med Date: 2009-10-22 Impact factor: 91.245
Authors: Glenn M Chertow; Elisabeth Burdick; Melissa Honour; Joseph V Bonventre; David W Bates Journal: J Am Soc Nephrol Date: 2005-09-21 Impact factor: 10.121
Authors: Paul M Palevsky; Jane Hongyuan Zhang; Theresa Z O'Connor; Glenn M Chertow; Susan T Crowley; Devasmita Choudhury; Kevin Finkel; John A Kellum; Emil Paganini; Roland M H Schein; Mark W Smith; Kathleen M Swanson; B Taylor Thompson; Anitha Vijayan; Suzanne Watnick; Robert A Star; Peter Peduzzi Journal: N Engl J Med Date: 2008-05-20 Impact factor: 91.245
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Sean M Bagshaw; Kevin B Laupland; Christopher J Doig; Garth Mortis; Gordon H Fick; Melissa Mucenski; Tomas Godinez-Luna; Lawrence W Svenson; Tom Rosenal Journal: Crit Care Date: 2005-10-25 Impact factor: 9.097
Authors: Eric A J Hoste; Gilles Clermont; Alexander Kersten; Ramesh Venkataraman; Derek C Angus; Dirk De Bacquer; John A Kellum Journal: Crit Care Date: 2006-05-12 Impact factor: 9.097