Quality Indicators of Continuous Renal Replacement Therapy (CRRT) Care in Critically Ill Patients: A Systematic Review
CCCF ePoster library. Rewa O. Nov 2, 2016; 150973
Disclosure(s): Baxter Inc.
Dr. Oleksa Rewa
Dr. Oleksa Rewa
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis

Quality Indicators of Continuous Renal Replacement Therapy (CRRT) Care in Critically Ill Patients: A Systematic Review


Oleksa Rewa1, Pierre-Marc Villeneuve1, Phillipe Lachance1 Dean T. Eurich2, Henry T Stelfox3, RT Noel Gibney1, Lisa Hartling4 Robin Featherstone4, Sean M Bagshaw1

1Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7; 22-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2E1; 3Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4; 4Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 4-486D Edmonton Clinic Health Academy, 11405 – 87 Avenue, Edmonton, Alberta, T6G 1C9 


Grant acknowledgements:
This study was supported through an unrestricted educational grant from Baxter Healthcare Corp.

Abstract:

Introduction: Renal replacement therapy is increasingly utilized in the intensive care unit (ICU) (1-3) of which continuous renal replacement therapy (CRRT) is most common (4,5). Despite CRRT being a relatively invasive and resource intensive technology; there remains wide practice variation in its application (6,7). This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients. 
Objectives: To identify QIs of CRRT care in critically ill patients.
Methods: A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle-Ottawa Scale (NOS) and Cochrane risk of bias tool. Data are summarized narratively.
Results: Our search yielded 8,374 citations, of which 138 fulfilled eligibility (Figure 1). This included 102 cohort studies, 24 randomized controlled trials, 10 case-control studies and 2 retrospective medical audits. Overall, the quality of retrieved studies was good. In total, 18 QIs were identified that were mentioned in 294 instances (Table 1). Identified QIs were classified as related to: structure (n=4, 22.2%), care processes (n=7, 38.9%) and outcomes (n=7; 38.9%). The most commonly mentioned QIs focused on: filter lifespan (n=102), small solute clearance (n=93), bleeding (n=32), delivered dose (n=21), and treatment interruption (n=5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n=144, 48.3%), scientifically acceptable (n=32, 10.7%) and useable and/or feasible (n=17, 5.7%) by their primary study authors (Table 2).
Conclusions: We identified 18 potential QIs of CRRT care characterized by heterogeneous definitions, varying quality of derivation and limited evaluation. Further study is needed to prioritize a concise inventory of QIs to measure, improve and benchmark CRRT care for critically ill patients.


References:

References:
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2. Rewa O, Bagshaw SM. Acute kidney injury-epidemiology, outcomes and economics. Nature reviews Nephrology. 2014;10(4):193-207.
3. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. Journal of the American Society of Nephrology : JASN. 2013;24(1):37-42.
4. Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive care medicine. 2007;33(9):1563-70.
6. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive care medicine. 2015;41(8):1411-23.
5. Overberger P, Pesacreta M, Palevsky PM. Management of renal replacement therapy in acute kidney injury: a survey of practitioner prescribing practices. Clinical journal of the American Society of Nephrology : CJASN. 2007;2(4):623-30.
6. Ricci Z, Ronco C, D'Amico G, De Felice R, Rossi S, Bolgan I, et al. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2006;21(3):690-6.



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