TY - JOUR

T1 - Calculating evidence-based renal replacement therapy – Introducing an excel-based calculator to improve prescribing and delivery in renal replacement therapy – A before and after study

AU - Cottle, Daniel

AU - Mousdale, Stephen

AU - Waqar-Uddin, Haroon

AU - Tully, Redmond

AU - Taylor, Benjamin

N1 - The final, definitive version of this article has been published in the Journal, Journal of the Intensive Care Society, 17 (1), 2016, © SAGE Publications Ltd, 2016 by SAGE Publications Ltd at the Journal of the Intensive Care Society page: http://inc.sagepub.com/ on SAGE Journals Online: http://online.sagepub.com/

PY - 2016/2

Y1 - 2016/2

N2 - Background Transferring the theoretical aspect of continuous renal replacement therapy to the bedside and delivering a given “dose” can be difficult. In research, the “dose” of renal replacement therapy is given as effluent flow rate in ml kg−1 h−1. Unfortunately, most machines require other information when they are initiating therapy, including blood flow rate, pre-blood pump flow rate, dialysate flow rate, etc. This can lead to confusion, resulting in patients receiving inappropriate doses of renal replacement therapy. Our aim was to design an excel calculator which would personalise patient's treatment, deliver an effective, evidence-based dose of renal replacement therapy without large variations in practice and prolong filter life. Our calculator prescribes a haemodialfiltration dose of 25 ml kg−1 h−1 whilst limiting the filtration fraction to 15%.MethodsWe compared the episodes of renal replacement therapy received by a historical group of patients, by retrieving their data stored on the haemofiltration machines, to a group where the calculator was used. In the second group, the data were gathered prospectively.ResultsThe median delivered dose reduced from 41.0 ml kg−1 h−1 to 26.8 ml kg−1 h−1 with reduced variability that was significantly closer to the aim of 25 ml kg−1.h−1 (p < 0.0001). The median treatment time increased from 8.5 h to 22.2 h (p = 0.00001).Conclusion Our calculator significantly reduces variation in prescriptions of continuous veno-venous haemodiafiltration and provides an evidence-based dose. It is easy to use and provides personal care for patients whilst optimizing continuous veno-venous haemodiafiltration delivery and treatment times.

AB - Background Transferring the theoretical aspect of continuous renal replacement therapy to the bedside and delivering a given “dose” can be difficult. In research, the “dose” of renal replacement therapy is given as effluent flow rate in ml kg−1 h−1. Unfortunately, most machines require other information when they are initiating therapy, including blood flow rate, pre-blood pump flow rate, dialysate flow rate, etc. This can lead to confusion, resulting in patients receiving inappropriate doses of renal replacement therapy. Our aim was to design an excel calculator which would personalise patient's treatment, deliver an effective, evidence-based dose of renal replacement therapy without large variations in practice and prolong filter life. Our calculator prescribes a haemodialfiltration dose of 25 ml kg−1 h−1 whilst limiting the filtration fraction to 15%.MethodsWe compared the episodes of renal replacement therapy received by a historical group of patients, by retrieving their data stored on the haemofiltration machines, to a group where the calculator was used. In the second group, the data were gathered prospectively.ResultsThe median delivered dose reduced from 41.0 ml kg−1 h−1 to 26.8 ml kg−1 h−1 with reduced variability that was significantly closer to the aim of 25 ml kg−1.h−1 (p < 0.0001). The median treatment time increased from 8.5 h to 22.2 h (p = 0.00001).Conclusion Our calculator significantly reduces variation in prescriptions of continuous veno-venous haemodiafiltration and provides an evidence-based dose. It is easy to use and provides personal care for patients whilst optimizing continuous veno-venous haemodiafiltration delivery and treatment times.

KW - Renal replacement therapy

KW - calculator

KW - continuous veno-venous haemodiafiltration

U2 - 10.1177/1751143715603383

DO - 10.1177/1751143715603383

M3 - Journal article

VL - 17

SP - 44

EP - 50

JO - Journal of the Intensive Care Society

JF - Journal of the Intensive Care Society

SN - 1751-1437

IS - 1

ER -