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The benefit of specialized team approaches in patients with acute kidney injury undergoing continuous renal replacement therapy: propensity score matched analysis

 Hyung Jung Oh  ;  Mi Jung Lee  ;  Chan Ho Kim  ;  Dae Young Kim  ;  Hye Sun Lee  ;  Jung Tak Park  ;  Sungwon Na  ;  Seung Hyeok Han  ;  Shin-Wook Kang  ;  Shin Ok Koh  ;  Tae-Hyun Yoo 
 CRITICAL CARE, Vol.18(4) : 1-9, 2014 
Journal Title
Issue Date
Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy* ; Critical Illness/mortality ; Critical Illness/therapy ; Female ; Humans ; Intensive Care Units/manpower ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Kaplan-Meier Estimate ; Male ; Medical Records/statistics & numerical data ; Middle Aged ; Outcome and Process Assessment (Health Care)/statistics & numerical data ; Patient Care Team/organization & administration* ; Patient Care Team/standards ; Patient Care Team/statistics & numerical data ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Renal Replacement Therapy/methods ; Renal Replacement Therapy/standards* ; Renal Replacement Therapy/statistics & numerical data ; Republic of Korea/epidemiology ; Retrospective Studies
Propensity Score ; Acute Kidney Injury ; Sequential Organ Failure Assessment ; Continuous Renal Replacement Therapy ; Propensity Score Match
INTRODUCTION: Continuous renal replacement therapy (CRRT) has been widely used in critically ill acute kidney injury (AKI) patients. Moreover, some centers operate a specialized CRRT team (SCT) composed of physicians and nurses, but few studies have yet determined the superiority of SCT control.
METHODS: A total of 334 among 534 patients in the original cohort, who started CRRT for severe AKI between August 2007 and September 2009 in Yonsei University Health System and were matched with a propensity score (PS), were divided into two groups based on SCT application. Moreover, we compared CRRT-related outcomes including down-time per day and lost time per filter-exchange between the two groups. The primary outcomes were 28- and 90-day all-cause mortality, and the secondary outcomes were the rates of renal function recovery at 28- and 90-day.
RESULTS: The down-time per day, lost time per filter-exchange, and red blood cell-transfused numbers during CRRT treatment were significantly lower after SCT approach compared with the group before SCT, while net ultrafiltration rate in the after SCT group was significantly higher compared to the before SCT group. During the study period, the 28- and 90-day all-cause mortality rates were significantly decreased after SCT application. Cox regression analysis revealed that 28- and 90-day all-cause mortality rates were significantly lower under SCT control, after adjusting for primary diagnosis, emergent surgical cases, Charlson Comorbidity Index and biochemical parameters. However, there were no significant differences in the rate of renal function recovery before and after SCT approach in CRRT.
CONCLUSIONS: A well-organized CRRT team could be beneficial for clinical outcomes through improving quality of care in AKI patients requiring CRRT treatment in the ICU.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Koh, Shin Ok(고신옥)
Kim, Chan Ho(김찬호)
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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