Comparison of a Kidney Intensive Care Unit Healthcare-Led Model versus a Traditional Haemodialysis Nurse-Led Model for Continuous Renal Replacement Therapy: A Retrospective Observational Study.
IF 2.6 3区 医学Q1 Pharmacology, Toxicology and Pharmaceutics
{"title":"Comparison of a Kidney Intensive Care Unit Healthcare-Led Model versus a Traditional Haemodialysis Nurse-Led Model for Continuous Renal Replacement Therapy: A Retrospective Observational Study.","authors":"Ting Zhang, Gaiying Jiang, Huinan Yan, Juzi Wang, Xin Lan, Jianming Bai, Yonghong Deng, Nan Zhang, Qian Gao, Yanting Shen, Xueqing Wang, Ruxian Wei","doi":"10.2147/TCRM.S545995","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The optimal organisational model for delivering continuous renal replacement therapy (CRRT) to critically ill patients remains a subject of investigation.</p><p><strong>Objective: </strong>This study compared the impact of a kidney intensive care unit (KICU) healthcare-led model with a traditional haemodialysis nurse-led model on key clinical process indicators and patient outcomes during CRRT.</p><p><strong>Methods: </strong>In this retrospective observational study, patients requiring CRRT admitted to the KICU of a tertiary hospital between January 2022 and December 2023 were selected. Patients were divided into two groups based on the treatment leadership: the KICU group, where CRRT was led by intensive care unit supervising physicians and nurses certified in critical care blood purification techniques, and the control group, led by supervising physicians and haemodialysis nurses. Data were collected via the hospital information system and nursing records. After propensity score matching, 1180 patients were included in each group. Supplementary multivariable regression analyses were performed to provide adjusted effect estimates. Outcomes included treatment interruption rate, catheter-related infection rate, complication rate, actual delivered effluent dose, catheter insertion to treatment initiation time and patient satisfaction.</p><p><strong>Results: </strong>The KICU group demonstrated a significantly lower overall complication rate (1.8% vs 3.7%, <i>p</i> = 0.004) and a higher rate of achieving the prescribed effluent dose (87.7% vs 81.2%, <i>p</i> < 0.001). Time to CRRT initiation was shorter in the KICU group (23.75 ± 2.43 vs 30.60 ± 6.36 minutes, <i>p</i> < 0.05). Patient satisfaction was also higher (<i>p</i> < 0.05). No significant differences were found in treatment interruption or catheter-related infections. The benefits of the KICU model on these key outcomes remained statistically significant in multivariable-adjusted analyses.</p><p><strong>Conclusion: </strong>Continuous renal replacement therapy management by a dedicated KICU multidisciplinary team was associated with a lower complication rate, improved delivery of the prescribed dialysis dose, faster treatment initiation and higher patient satisfaction compared with a traditional model. These findings suggest that a structured, healthcare-led model can optimise the CRRT process for critically ill patients. Further multicentre studies are warranted to confirm these results.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"545995"},"PeriodicalIF":2.6000,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998925/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutics and Clinical Risk Management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/TCRM.S545995","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The optimal organisational model for delivering continuous renal replacement therapy (CRRT) to critically ill patients remains a subject of investigation.
Objective: This study compared the impact of a kidney intensive care unit (KICU) healthcare-led model with a traditional haemodialysis nurse-led model on key clinical process indicators and patient outcomes during CRRT.
Methods: In this retrospective observational study, patients requiring CRRT admitted to the KICU of a tertiary hospital between January 2022 and December 2023 were selected. Patients were divided into two groups based on the treatment leadership: the KICU group, where CRRT was led by intensive care unit supervising physicians and nurses certified in critical care blood purification techniques, and the control group, led by supervising physicians and haemodialysis nurses. Data were collected via the hospital information system and nursing records. After propensity score matching, 1180 patients were included in each group. Supplementary multivariable regression analyses were performed to provide adjusted effect estimates. Outcomes included treatment interruption rate, catheter-related infection rate, complication rate, actual delivered effluent dose, catheter insertion to treatment initiation time and patient satisfaction.
Results: The KICU group demonstrated a significantly lower overall complication rate (1.8% vs 3.7%, p = 0.004) and a higher rate of achieving the prescribed effluent dose (87.7% vs 81.2%, p < 0.001). Time to CRRT initiation was shorter in the KICU group (23.75 ± 2.43 vs 30.60 ± 6.36 minutes, p < 0.05). Patient satisfaction was also higher (p < 0.05). No significant differences were found in treatment interruption or catheter-related infections. The benefits of the KICU model on these key outcomes remained statistically significant in multivariable-adjusted analyses.
Conclusion: Continuous renal replacement therapy management by a dedicated KICU multidisciplinary team was associated with a lower complication rate, improved delivery of the prescribed dialysis dose, faster treatment initiation and higher patient satisfaction compared with a traditional model. These findings suggest that a structured, healthcare-led model can optimise the CRRT process for critically ill patients. Further multicentre studies are warranted to confirm these results.
背景：为危重患者提供持续肾替代治疗（CRRT）的最佳组织模式仍然是一个研究课题。目的：比较肾重症监护病房（KICU）医护人员主导模式与传统血液透析护士主导模式对CRRT期间关键临床过程指标和患者预后的影响。方法：本回顾性观察研究选择2022年1月至2023年12月在某三级医院KICU住院的CRRT患者。根据治疗领导将患者分为两组：KICU组，CRRT由重症监护监护医生和具有重症监护血液净化技术认证的护士领导，对照组由监护医生和血液透析护士领导。通过医院信息系统和护理记录收集数据。倾向评分匹配后，每组纳入1180例患者。补充多变量回归分析提供调整后的效果估计。结果包括治疗中断率、导管相关感染率、并发症发生率、实际流出液剂量、置管至治疗开始时间和患者满意度。结果：KICU组总并发症发生率显著低于对照组（1.8% vs 3.7%, p = 0.004），出水达到规定剂量率显著高于对照组（87.7% vs 81.2%, p < 0.001）。KICU组开始CRRT的时间较短（23.75±2.43 vs 30.60±6.36,p < 0.05）。患者满意度也较高（p < 0.05）。在治疗中断或导管相关感染方面没有发现显著差异。在多变量调整分析中，KICU模型对这些关键结果的益处仍然具有统计学意义。结论：与传统模式相比，由专门的KICU多学科团队进行持续肾脏替代治疗可降低并发症发生率，改善透析剂量的交付，更快的治疗开始和更高的患者满意度。这些发现表明，一个结构化的、以医疗保健为主导的模型可以优化危重患者的CRRT过程。需要进一步的多中心研究来证实这些结果。
期刊介绍：
Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas.
The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature.
As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication.
The journal does not accept study protocols, animal-based or cell line-based studies.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
