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논문분류	춘계학술대회 초록집
제목	Optimizing CKRT dose prescription, as the first step for green nephrology
저자	Taeil Kim
출판정보	2024; 2024(1):
키워드
초록	Objectives: Kidney Disease Improving Global Outcomes (KDIGO) recommends a continuous kidney replacement therapy (CKRT) dose of 20-25 mL/kg/h. However, in South Korea, the dose of CKRT is usually higher than 30-35 mL/kg/h. Unnecessarily high dose increases water waste. Therefore, our center conducted a quality improvement initiative (QI) to deliver an appropriate dose of CKRT. Methods: This is a single-center, prospective pilot study conducted from 1 May to 31 December 2023 including 441 patients. The CKRT prescription dose was adjusted from the previous 35 mL/kg/hr to 25-30 mL/kg/hr, with a target actual delivered dose of 20-25 mL/kg/hr. The primary outcome was the proportion of patients with an actual delivered dose of 20-25 mL/min/kg, and the secondary outcomes were changes in daily water use per person and in-hospital mortality before and after QI. Results: Before QI (N=210), the mean prescribed dose of CKRT was 34.4 mL/kg/hr, almost 90% of which was actually delivered, and the mean amount of water used per person was 53.6±16.9 L/day. During the QI periods, 105 out of 231 (45.5%) were prescribed a CKRT dose between 25 and 30 mL/kg/hr, the median actually delivered dose was reduced to 27.4 mL/kg/hr (P<0.001), and 52 cases (22.5%) achieved an average dose of 20 to 25 mL/kg/hr. After QI (N=231), the daily use of dialysate or replacement soloution bags decreased from 10.7 bags to 9.4 bags, a reduction of approximately 1.3 bags per day (P<0.001), and water volume was reduced by 12.7%, equivalent to 6.8 liters per day (46.8±15.1 L/day, P<0.001). There was no difference in in-hospital mortality before and after the QI period. Conclusions: By reducing the CKRT dose to the KDIGO recommended level, we were able to reduce water use by 12.7%, which is 6.8 liters per day for each patient, with no additional harm to the patients receiving CKRT.
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