Impact of computerized order entry and pre-mixed dialysis solutions for continuous veno-venous hemodiafiltration on selection of therapy for acute renal failure

Lawand Saadulla, W. Brian Reeves, Brittany Irey, Nasrollah Ghahramani

Research output: Contribution to journalArticle

Abstract

To investigate the impacts of availability of premixed solutions and computerized order entry on nephrologists' choice of the initial mode of renal replacement therapy in acute renal failure.We studied 898 patients with acute renal failure in 3 consecutive eras: era 1 (custom-mixed solution; n=309), era 2 (pre-mixed commercial solution; n=324), and era 3 (post-computerized order entry; n=265). The proportion of patients treated with renal replacement therapy and the time from consult to initiation of continuous renal replacement therapy was similar in the 3 eras. Following introduction of the pre-mixed solution, the proportion of patients treated with continuous renal replacement therapy increased (20% vs. 33%; p<0.05), it was initiated at a lower serum creatinine (353±123 μmol/L vs. 300±80 μmol/L; p<0.05) and in older patients (53±12 vs. 61±14 years; p<0.05). There was a progressive increase in the use of continuous veno-venous hemodialysis (18% vs. 79% vs. 100%; p<0.05) and in the total prescribed flow rate (1,382±546 vs. 2,324±737 vs. 2,900±305 mL/hr 3; p<0.05). There was no significant impact on mortality. The availability of a pre-mixed solution increases the likelihood of initiating continuous renal replacement therapy in acute renal failure, initiating it at a lower creatinine and for older patients, use of continuous veno-venous hemodialysis and higher prescribed continuous renal replacement therapy dose. Computerized order entry implementation is associated with an additional increase in the use of continuous veno-venous hemodialysis, higher total prescribed dialysis dose, and use of CRRT among an increasing number of patients not on mechanical ventilation. The effect of these changes on patient survival is not significant.

Original languageEnglish (US)
Pages (from-to)223-231
Number of pages9
JournalJournal of Medical Systems
Volume36
Issue number1
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Keywords

  • Acute renal failure
  • CRRT
  • Computerized order entry
  • Hemodialysis

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Information Systems
  • Health Informatics
  • Health Information Management

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