Cost analysis of continuous renal replacement and extended hemodialysis

Abstract

BACKGROUND: Continuous renal replacement therapies (CRRTs) are now considered routinely in the treatment of patients with acute kidney injury (AKI) in the intensive care (ICU) setting. In search of the most effective modality, cost becomes important. METHODS: Of the various modalities utilizing convection, diffusion, or a combination of the two, continuous venovenous hemodiafiltration (CVVHDF) and extended hemodialysis procedures (including sustained low-efficiency dialysis [SLED]) are the most common in the United States; both have been noted to be effective in delivering an adequate dialysis dose. This study compared the costs of these two therapies in two Philadelphia teaching hospitals. RESULTS: The cost for delivery of 24 hours of CVVHDF using the Gambro-Prisma machine was found to be $1,602 versus $423 for 12 hours of SLED therapy with the Fresenius 2008K machine. Twenty-four hours of SLED would cost $797, and the cost can be decreased to $77 if the nursing-to-patient ratio is increased from 1:1 to 1:2. CONCLUSIONS: Higher material costs were primarily responsible for the expense of CVVHDF. Given that the dose deliveries are similar, SLED remains the most cost-effective option for delivering renal replacement in the ICU setting. These costs may not exactly mirror those of other institutions depending on the types of solutions used, the filters utilized, salary differences based on geographical location, and the intensity of CRRT delivered.