A Decision-Making Algorithm for Initiation and Discontinuation of RRT in Severe AKI

AKI is an increasingly common and devastating complication in hospitalized patients. Severe AKI requiring RRT is associated with in-hospital mortality rates exceeding 40%. Clinical decision making related to RRT initiation for patients with AKI in the medical intensive care unit is not standardized....

Full description

Saved in:
Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2017-02, Vol.12 (2), p.228-236
Main Authors: Mendu, Mallika L, Ciociolo, Jr, George R, McLaughlin, Sarah R, Graham, Dionne A, Ghazinouri, Roya, Parmar, Siddharth, Grossier, Alissa, Rosen, Rebecca, Laskowski, Karl R, Riella, Leonardo V, Robinson, Emily S, Charytan, David M, Bonventre, Joseph V, Greenberg, Jeffrey O, Waikar, Sushrut S
Format: Article
Language:English
Subjects:
Academic Medical Centers
Acute Kidney Injury - mortality
Acute Kidney Injury - therapy
Aged
Algorithms
Clinical Decision-Making
Clinical Protocols
Decision Support Techniques
Female
Guideline Adherence
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Original
Prospective Studies
Renal Replacement Therapy
Severity of Illness Index
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:AKI is an increasingly common and devastating complication in hospitalized patients. Severe AKI requiring RRT is associated with in-hospital mortality rates exceeding 40%. Clinical decision making related to RRT initiation for patients with AKI in the medical intensive care unit is not standardized. We conducted a 13-month (November of 2013 to December of 2014) prospective cohort study in an academic medical intensive care unit involving the implementation of an AKI Standardized Clinical Assessment and Management Plan, a decision-making algorithm to assist front-line clinicians caring for patients with AKI. The Standardized Clinical Assessment and Management Plan algorithms provided recommendations about optimal indications for initiating and discontinuing RRT on the basis of various clinical parameters; 176 patients managed by nine nephrologists were included in the study. We captured reasons for deviation from the recommended algorithm as well as mortality data. Patients whose clinicians adhered to the Standardized Clinical Assessment and Management Plan recommendation to start RRT had lower in-hospital mortality (42% versus 63%; P
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.07170716