Comparing prescribed and delivered doses in ICU patients on continuous renal replacement therapy at King Fahad Hospital Saudi Arabia.

Abstract

The outcomes of several studies to assess the dose of dialysis during renal replacement therapy (RRT) created confusion among the clinicians to considered that dose of dialysis can influence the outcomes of patients with acute kidney injury (AKI). Suitable dose of CRRT is associated with improved survival in critically ill patients with acute kidney injury (AKI). Among different studies Effluent Volume per weight and unit time (mL/kg/h) used to express prescribed effluent rates, in our study same unit used express the effluent rates. Purpose of this study is to find the difference among dosage of CRRT based on effluent rate prescription and actual delivered effluent rate by monitoring records of dialysis. Study Design: Prospective observational cohort study. Setting: King Fahad Hospital Medina Saudi Arabia. Period: 1st June 2016 to 31st December 2016. Material & Methods: Two hundred acute kidney injury patients admitted in ICU on CRRT at rate of 20ml/kg using pre-filter continuous venovenous hemodia-filtration (CVVHDF), among (AKI) patients prescribed doses were compared with the actual dose with in the duration of 24 hours to find out difference between prescribed and actual dose. Results: Findings of our study shows that. Mean average dose of dialysis delivered per day was only 16 hours which is 21% of prescription of pre-dilution CVVHDF. Patients were receiving 14ml/Kg of continues renal replacement therapy (CRRT) with the lack of 21% dilution correction factor. The average number of hours/day on continuous renal replacement therapy was 14.1±2.41, with a mean flow rate of 1.36±0.31 L/h (averaged over 24 h). The delivered doses were significantly lowered then the prescribed doses with (P < 0.001). 30% of doses was missing during CRRT among patients with acute kidney diseases admitted in ICU at king Fahad hospital Saudi Arabia (P-value <0.001). Conclusions: We concluded that during dialysis patients did not received the prescribed dose in comparison to actual delivered dose which effects the survival of critical ill patients with acute kidney injury.