The landscape of renal replacement therapy in Veterans Affairs Medical Center intensive care units

Abstract

Background: Outpatient dialysis is standardized with several evidence-based measures of adequacy and quality that providers aim to meet while providing treatment. By contrast, in the intensive care unit (ICU) there are different types of prolonged and continuous renal replacement therapies (PIRRT and CRRT, respectively) with varied strategies for addressing patient care and a dearth of nationally accepted quality parameters. To eventually describe appropriate quality measures for ICU-related renal replacement therapy (RRT), we first aimed to capture the variety and prevalence of basic strategies and equipment utilized in the ICUs of Veteran Affairs (VA) medical facilities with inpatient hemodialysis capabilities. Methods: Via email to the dialysis directors of all VA facilities that provided inpatient hemodialysis during 2018, we requested survey participation regarding aspects of RRT in VA ICUs. Questions centered around the mode of therapy, equipment, solutions, prescription authority, nursing, anticoagulation, antimicrobial dosing, and access. Results: Seventy-six centers completed the questionnaire, achieving a response rate of 87.4%. Fifty-five centers reported using PIRRT or CRRT in addition to intermittent hemodialysis. Of these centers, 42 reported being specifically CRRT-capable. Over half of respondents had the capabilities to perform PIRRT. Twelve centers (21.8%) were equipped to use slow low efficient dialysis (SLED) alone. Therapy was largely prescribed by nephrologists (94.4% of centers). Conclusions: Within the VA system, ICU-related RRT practice is quite varied. Variation in processes of care, prescription authority, nursing care coordination, medication management, and safety practices present opportunities for developing cross-cutting measures of quality of intensive care RRT that are agnostic of modality choice.

Long-term arteriovenous fistula prognosis for maintenance hemodialysis patients who accepted PIRRT by using arteriovenous fistula

“…[17][18][19] Several studies suggested that the use of AVF for PIRRT may not have a significant effect on AVF function. 20 However, the evidences were associated with small sample size and short follow-up term. Currently, there were controversial opinions on the use of AVF for PIRRT in hospitalized MHD patients.…”

Nursing Countermeasures of Continuous Renal Replacement Treatment in End-Stage Renal Disease with Refractory Hypotension in the Context of Smart Health

“…In recent years, the diagnostic criteria for the disease are also changing due to the continuous changes in disease guidelines. Currently, chronic kidney disease stage 5 is end-stage renal disease [ 18 ]. Dialysis is often used clinically to reduce the burden on the kidneys, so as to relieve the patient's condition.…”

Prolonged Intermittent Kidney Replacement Therapy

“…Until recently, the use of PIKRT was more prevalent in emerging countries (8), but during the COVID-19 pandemic, PIKRT was utilized in numerous centers that experienced patient surges, especially in the United States and Europe (9). A recent paper also described the growing use of PIKRT among the Veteran Administration hospitals in the United States (10).…”