Abstract
Acute kidney injury in the intensive care unit (ICU) requiring renal replacement therapy (RRT) is common and mortality is high. The dose delivered is important and is usually inadequate. Evidence for dose is quoted as clearance, but RRT is usually prescribed as pump flow rates. Accurately delivering an evidence-based dose to a patient is difficult because of inefficiencies of RRT, the complexity of its mathematics and poor understanding. Inadequate dose can result from inadequate prescribing, which should be by ideal body weight and possibly by indication. Inadequate delivery of a prescription can occur because the delivered dose depends not only on the dialysate and ultrafiltrate pump flow rates, but also blood flow rate, predilution inefficiency, fluid removal rate and downtime. To investigate the feasibility of using a web-based calculator to make prescribing by clearance easy and to predict and compensate for these factors, a web page with a RRT calculator using JavaScript was used. Data were collected from 19 treatments before the introduction of the calculator and 20 after. Results showed that dose delivery was significantly improved (p<0.001). There was an improvement in prescribing an evidence-based dose which did not reach statistical significance (p=0.056) but the standard deviation was significantly smaller, indicating more rational prescribing. The calculator significantly improved prescribing and delivery of RRT in our ICU.