Nattachai Srisawat, Loredo Lawsin, Shigehiko Uchino, Rinaldo Bellomo, John A Kellum, The B.E.S.T. Kidney Investigators; Critical Care 2010, 14:R46 (26 March 2010)
Introduction
Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites and, to date, only single-center cost studies have been performed. The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU).
Methods
Post hoc analysis of a prospective observational study among 53 centers from 23 countries, from September 2000 to December 2001. We estimated costs based on staffing, as well as dialysate and replacement fluid, anticoagulation and extracorporeal circuit.
Results
We found that the theoretical range of costs were from $3,629.8/day more with CRRT to $378.6/day more with IRRT. The median difference in cost between CRRT and IRRT was $289.6 (IQR 830.8-116.8) per day (greater with CRRT). Costs also varied greatly by region. Reducing replacement fluid volumes in CRRT to not more than 25 ml/min (approximately 25 ml/kg/hr) would result in $67.2/day (23.2 %) mean savings.
Conclusions
Cost considerations with RRT are important and vary substantially among centers. We identified the relative impact of four cost domains (nurse staffing, fluid, anticoagulation, and extracorporeal circuit) on overall cost differences and hospitals can look to these areas in order to reduce costs associated with RRT.
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