Cost of acute renal failure requiring dialysis in the intensive care unit: Clinical and resource implications of renal recovery
Cost of acute renal failure requiring dialysis in the intensive care unit: Clinical and resource implications of renal recovery
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DOI：
10.1097/01.ccm.0000045182.90302.b3
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发表时间：
2003-02-01
影响因子：
8.8
通讯作者：
Donaldson, C
中科院分区：
文献类型：
--
作者：
Manns, B;Doig, CJ;Donaldson, C
目的：急性肾功能衰竭可采用连续性肾脏替代治疗（CRRT）或间歇性血液透析治疗。尽管接受CRRT治疗的患者肾脏恢复率可能更高，但死亡率无差异。考虑到这些因素，按方式估计成本可能有助于选择透析方法。因此，本研究的目的是评估重症监护室中CRRT和间歇性血液透析的成本，并探讨肾功能恢复对随后的临床结局和幸存者成本的影响。设计：回顾性队列研究，研究对象为1996年4月1日至1999年3月31日期间发生急性肾功能衰竭并需要透析的所有患者。两个三级护理重症监护病房在卡尔加里，加拿大。患者：共261危重患者。干预措施：无。测量：所有患者进行了跟踪，以确定在医院和随后的临床结果（生存率和频率的肾脏恢复）。CRRT和间歇性血液透析的直接和潜在的长期成本measured.Main Results：进行CRRT的成本范围从3，486加元到5，117加元，取决于所使用的方式和抗凝剂，并且比间歇性血液透析（每周1，342加元）昂贵得多。肾功能恢复的幸存者住院天数明显减少（11.3 vs. 22.5天，p < .001），医疗费用更少（$11，192 vs.$73，273，p <0.001）在出院后的一年内与仍在透析的幸存者相比。在重症监护室中，通过增加对急性肾衰竭患者使用间歇性血液透析而不是CRRT，可以立即节省成本。由于持续透析的高成本，如果CRRT能改善幸存者的肾脏恢复，它仍可能是一种经济有效的治疗方法;需要在该领域进行进一步研究。
Objective: Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choosing the method of dialysis. As such, the objective of this study was to estimate the cost of CRRT and intermittent hemodialysis in the intensive care unit and to explore the impact of renal recovery on subsequent clinical outcomes and costs among survivors.Design: Retrospective cohort study of all patients who developed acute renal failure and required dialysis between April 1, 1996, and March 31, 1999.Setting: Two tertiary care intensive care units in Calgary, Canada.Patients: A total of 261 critically ill patients.Interventions: None.Measurements: All patients were followed to determine in-hospital and subsequent clinical outcomes (survival and frequency of renal recovery). The immediate and potential long-term costs of CRRT and intermittent hemodialysis were measured.Main Results: The cost of performing CRRT ranged from Can $3,486 to Can $5,117 per week, depending on the modality and the anticoagulant used, and it was significantly more expensive than intermittent hemodialysis (Can $1,342 per week). Survivors with renal recovery spent significantly fewer days in hospital (11.3 vs. 22.5 days, p < .001) and incurred less healthcare costs ($11,192 vs. $73,273, p < .001) over the year after hospital discharge compared with survivors who remained on dialysis.Conclusions: Immediate cost savings could be achieved by increasing the use of intermittent hemodialysis rather than CRRT for patients with acute renal failure in the intensive care unit. Because of the high cost of ongoing dialysis, CRRT may still be an economically efficient treatment if it improves renal recovery among survivors; further study in this area is required.