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Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review

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Abstract

Objectives

Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients.

Design

A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected, and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle–Ottawa Scale (NOS) and Cochrane risk of bias tool. Data were summarized narratively.

Measurements and main results

Our search yielded 8374 citations, of which 133 fulfilled eligibility. This included 97 cohort studies, 24 randomized controlled trials, 10 case-control studies, and 2 retrospective medical audits. The quality of retrieved studies was generally good. In total, 18 QIs were identified that were mentioned in 238 instances. Identified QIs were classified as related to structure (n = 4, 22.2 %), care processes (n = 9, 50.0 %), and outcomes (n = 5, 27.8 %). The most commonly mentioned QIs focused on filter lifespan (n = 98), small solute clearance (n = 46), bleeding (n = 30), delivered dose (n = 19), and treatment interruption (n = 5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n = 144, 48.3 %), scientifically acceptable (n = 32, 10.7 %), and useable and/or feasible (n = 17, 5.7 %) by their primary study authors.

Conclusions

We identified numerous potential QIs of CRRT care, characterized by heterogeneous definitions, varying quality of derivation, and limited evaluation. Further study is needed to prioritize a concise inventory of QIs to measure, improve, and benchmark CRRT care for critically ill patients.

Systematic review registration

PROSPERO CRD42015015530.

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Abbreviations

CRRT:

Continuous renal replacement therapy

ICU:

Intensive care unit

RRT:

Renal replacement therapy

QI:

Quality indicator

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Acknowledgments

S.M.B. is supported by a Canada Research Chair in Critical Care Nephrology. D.T.E. is supported by a Canada Research Chair in Chronic Disease Prevention and Management. H.T.S. is supported by a Population Health Investigator award from Alberta Innovates: Health Solutions. The authors gratefully acknowledge the contribution of Tara Landry for her peer-review of the Ovid Medline search strategy. This study was supported through an unrestricted educational grant from Baxter Healthcare Corp.

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada

    Oleksa G. Rewa, Pierre-Marc Villeneuve, Philippe Lachance, R. T. Noel Gibney & Sean M. Bagshaw

  2. 2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada

    Dean T. Eurich

  3. Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada

    Henry T. Stelfox

  4. Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 4-486D Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada

    Lisa Hartling & Robin Featherstone

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  1. Oleksa G. Rewa
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  2. Pierre-Marc Villeneuve
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  7. Lisa Hartling
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  9. Sean M. Bagshaw
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Corresponding author

Correspondence to Oleksa G. Rewa.

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Conflicts of interest

SM.B. and R.T.N.G. have consulted and received honoraria from Baxter Inc. O.G.R. is supported by an unrestricted educational grant from Baxter Inc. Baxter Inc. has had no role in the study conception, protocol development, article selection, analysis, or preparation of this manuscript.

Additional information

Work performed at the University of Alberta.

Take-home message: We identified 18 potential quality indicators (QIs) of continuous renal replacement therapy (CRRT) care in the current literature. However, as a result of significant definition heterogeneity and limited evaluation, further study is needed to better prioritize these QIs to measure, improve, and benchmark CRRT care for critically ill patients.

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Rewa, O.G., Villeneuve, PM., Lachance, P. et al. Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review. Intensive Care Med 43, 750–763 (2017). https://doi.org/10.1007/s00134-016-4579-x

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