The Landscape of Renal Replacement Therapy in Veterans Affairs Medical Center Intensive Care Units

Authors

Chandan Vangala
Maulin Shah
Natasha N Dave
Layth Al Attar
Sankar D Navaneethan
Venkat Ramanathan
Susan Crowley
Wolfgang C Winkelmayer

Publication Date

12-1-2021

Journal

Renal Failure

DOI

10.1080/0886022X.2021.1949347

PMID

34261420

PMCID

PMC8280999

PubMedCentral® Posted Date

7-14-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Acute Kidney Injury, Female, Hospitals, Veterans, Humans, Intensive Care Units, Male, Renal Replacement Therapy, United States, Continuous renal replacement therapy, prolonged intermittent renal replacement therapy, CRRT, PIRRT, veterans affairs, intensive care unit

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:

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.

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