Table 3.
Process of renal replacement therapy indication and treatment initiation
| Funding source | ||||
|---|---|---|---|---|
| Public (n = 24) | Mixed (n = 18) | Private (n = 19) | Total (n = 61) | |
| Which process best represents the approach for starting renal replacement therapy in your unit? | ||||
| An intensivist establishes the diagnosis of acute kidney injury and indicates the need for replacement therapy. A nephrologist prescribes renal replacement therapy. | 2/21 (9.5) | 3/18 (16.7) | 1/19 (5.3) | 6/58 (10.3) |
| An intensivist establishes the diagnosis of acute kidney injury and requests assessment by a nephrologist. The nephrologist determines the indication and prescribes renal replacement therapy. | 18/21 (85.7) | 10/18 (55.6) | 15/19 (78.9) | 43/58 (74.1) |
| An intensivist establishes the diagnosis of acute kidney injury and discusses with the attending physician the need for assessment by a nephrologist. The nephrologist is called and discusses with the staff the need for renal replacement therapy. The nephrologist prescribes renal replacement therapy. | 1/21 (4.8) | 2/18 (11.1) | 3/19 (15.8) | 6/58 (10.3) |
| The ICU staff includes a nephrologist who is in charge of the assessment and follow-up of patients with acute kidney injury and prescribes replacement therapy as needed. | 0/21 (0) | 3/18 (16.7) | 0/19 (0) | 3/58 (5.2) |
| What is the average time from indication to initiation of renal replacement therapy? | ||||
| < 2 hours | 3/21 (14.3) | 7/18 (38.9) | 4/19 (21.1) | 14/58 (24.1) |
| 2 - 4 hours | 4/21 (19) | 4/18 (22.2) | 12/19 (63.2) | 20/58 (34.5) |
| 4 - 6 hours | 6/21 (28.6) | 1/18 (5.6) | 3/19 (15.8) | 10/58 (17.2) |
| > 6 hours | 8/21 (38.1) | 5/18 (27.8) | 0/19 (0) | 13/58 (22.4) |
| I don’t know | 0/21 (0) | 1/18 (5.6) | 0/19 (0) | 1/58 (1.7) |
| What is the limiting step in the process of starting renal replacement therapy once it is prescribed? | ||||
| Nephrologist assessment | 0/21 (0) | 1/18 (5.6) | 7/19 (36.8) | 8/58 (13.8) |
| Bureaucracy (e.g., payer’s authorization) | 0/21 (0) | 0/18 (0) | 0/19 (0) | 0/58 (0) |
| Equipment availability | 7/21 (33.3) | 11/18 (61.1) | 1/19 (5.3) | 19/58 (32.8) |
| Availability of personnel to start the procedure | 10/21 (47.6) | 4/18 (22.2) | 5/19 (26.3) | 19/58 (32.8) |
| Adequate vascular access | 4/21 (19) | 2/18 (11.1) | 6/19 (31.6) | 12/58 (20.7) |
| Other | 0/21 (0) | 0/18 (0) | 0/19 (0) | 0/58 (0) |
ICU - intensive care unit. The results are expressed as n/n total (%).