ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO095

Continuous Renal Replacement Therapy Dosing in Critically Ill Patients

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Griffin, Benjamin, University of Colorado, Aurora, Colorado, United States
  • Thomson, Amanda, University of Colorado Hospital, Aurora, Colorado, United States
  • Yoder, Mark, UCHealth, Aurora, Colorado, United States
  • Bortolotto, Shannon Johnson, Univeristy of Colorado Hospital/UCHealth, Aurora, Colorado, United States
  • Bonnes, Deb G, UCHealth, Aurora, Colorado, United States
  • Dufficy, Lisa M, University of Colorado Hospital, Aurora, Colorado, United States
  • Bregman, Adam Philip, None, Denver, Colorado, United States
  • Faubel, Sarah, University of Colorado Denver, Denver, Colorado, United States
  • Jalal, Diana I., University of Colorado Denver Health Science Center, Aurora, Colorado, United States
Background

Continuous Renal Replacement Therapy (CRRT) is a commonly performed procedure in critically ill patients with acute kidney injury (AKI) in the intensive care unit (ICU). National guidelines from Kidney Disease Improving Global Outcomes (KDIGO) give a level 1A recommendation that CRRT should be prescribed to achieve a daily dose of 20-25 ml/kg/hr. Unfortunately, nationwide prescribing practices are quite variable, including among renal staff at the University of Colorado Hospital (UCH).

Methods

Our aim was to deliver a 20-25 mL/kg/hr average daily dose of CRRT in >80% of daily sessions. All patients at UCH who received CRRT were included. Key interventions included modifications to the CRRT flowsheet in EPIC to display actual delivered dose in terms of mL/kg/hr, development of a “CRRT Provider Protocol” to standardize CRRT delivery across the division, implementation of a CRRT didactic session within the clinical fellows’ core curriculum, and an update of the standard CRRT procedure note to include the 24-hour average delivered dose. The outcome variable was % of patients with CRRT dosing in the range of 20-25 mL/kg/hr. Process variables included % of CRRT hours charted correctly by the nursing staff, and % of nephrology notes that record the dose. Balancing measures included nursing satisfaction and time spent charting.

Results

The above implementations were employed starting in February 2017. Prior to then only 32% of patients had an average daily delivered CRRT dose in the range of 20-25 mL/kg/hr. The median value since implementation in 62% (Figure 1). Nurses accurately charted the dosing variables 87% of the time when the new flowsheet was implemented, which has since risen to 96% charting accuracy. 100% of nurses surveyed feel their workload is the same or less with the new flowsheet.

Conclusion

Achieving the KDIGO recommended guidelines of delivering CRRT at 20-25 mL/kg/hr is achievable using EMR tools, and does not significantly increase the workload for nephrologists or nursing staff.