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


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To investigate the impacts of availability of pre-mixed 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 ?mol/L vs. 300?80 ?mol/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.

Resumo Limpo

investig impact avail premix solut computer order entri nephrologist choic initi mode renal replac therapi acut renal failur studi patient acut renal failur consecut era era custommix solut n era premix commerci solut n era postcomputer order entri n proport patient treat renal replac therapi time consult initi continu renal replac therapi similar era follow introduct premix solut proport patient treat continu renal replac therapi increas vs p initi lower serum creatinin moll vs moll p older patient vs year p progress increas use continu venoven hemodialysi vs vs p total prescrib flow rate vs vs mlhr p signific impact mortal avail premix solut increas likelihood initi continu renal replac therapi acut renal failur initi lower creatinin older patient use continu venoven hemodialysi higher prescrib continu renal replac therapi dose computer order entri implement associ addit increas use continu venoven hemodialysi higher total prescrib dialysi dose use crrt among increas number patient mechan ventil effect chang patient surviv signific

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