Department of Nephrology/Hypertension, University of Berne, Berne, Switzerland.
Artif Organs. 2009 Aug;33(8):634-40. doi: 10.1111/j.1525-1594.2009.00794.x. Epub 2009 Jun 28.
Intermittent and continuous renal replacement therapies (RRTs) are available for the treatment of acute renal failure (ARF) in the intensive care unit (ICU). Although at present there are no adequately powered survival studies, available data suggest that both methods are equal with respect to patient outcome. Therefore, cost comparison between techniques is important for selecting the modality. Expenditures were prospectively assessed as a secondary end point during a controlled, randomized trial comparing intermittent hemodialysis (IHD) with continuous venovenous hemodiafiltration (CVVHDF). The outcome of the primary end points of this trial, that is, ICU and in-hospital mortality, has been previously published. One hundred twenty-five patients from a Swiss university hospital ICU were randomized either to CVVHDF or IHD. Out of these, 42 (CVVHDF) and 34 (IHD) were available for cost analysis. Patients' characteristics, delivered dialysis dose, duration of stay in the ICU or hospital, mortality rates, and recovery of renal function were not different between the two groups. Detailed 24-h time and material consumption protocols were available for 369 (CVVHDF) and 195 (IHD) treatment days. The mean daily duration of CVVHDF was 19.5 +/- 3.2 h/day, resulting in total expenditures of Euro 436 +/- 21 (21% for human resources and 79% for technical devices). For IHD (mean 3.0 +/- 0.4 h/treatment), the costs were lower (Euro 268 +/- 26), with a larger proportion for human resources (45%). Nursing time spent for CVVHDF was 113 +/- 50 min, and 198 +/- 63 min per IHD treatment. Total costs for RRT in ICU patients with ARF were lower when treated with IHD than with CVVHDF, and have to be taken into account for the selection of the method of RRT in ARF on the ICU.
间歇性和连续性肾脏替代治疗（RRT）可用于治疗重症监护病房（ICU）中的急性肾衰竭（ARF）。尽管目前尚无足够的生存能力研究，但现有数据表明，这两种方法在患者预后方面是相同的。因此，对于选择治疗方法，技术之间的成本比较很重要。在一项比较间歇性血液透析（IHD）与连续性静脉-静脉血液透析滤过（CVVHDF）的对照、随机试验中，作为次要终点前瞻性评估了支出。该试验的主要终点（即 ICU 和院内死亡率）的结果已在之前发表。瑞士一所大学医院 ICU 的 125 名患者被随机分配到 CVVHDF 或 IHD 组。其中，42 名（CVVHDF）和 34 名（IHD）可进行成本分析。两组患者的特征、给予的透析剂量、在 ICU 或医院的停留时间、死亡率和肾功能恢复情况均无差异。有 369 个（CVVHDF）和 195 个（IHD）治疗日的详细 24 小时时间和材料消耗方案。CVVHDF 的平均每日持续时间为 19.5 +/- 3.2 小时/天，总支出为 436 +/- 21 欧元（人力资源占 21%，技术设备占 79%）。对于 IHD（平均 3.0 +/- 0.4 小时/次治疗），成本较低（436 +/- 26 欧元），人力资源占比更大（45%）。CVVHDF 的护理时间为 113 +/- 50 分钟，IHD 每次治疗的护理时间为 198 +/- 63 分钟。在 ICU 中患有 ARF 的患者中，与 CVVHDF 相比，使用 IHD 进行 RRT 的总成本较低，因此在 ICU 中选择 ARF 的 RRT 方法时必须考虑这些成本。
