Key Performance Indicators for Acute Intermittent Renal Replacement Therapy in Critically Ill Patients: A Systematic Review.

INTRODUCTION

Several initiatives have tried to identify key performance indicators (KPIs) for continuous renal replacement therapy. Nevertheless, no reviews of the literature for KPIs of intermittent renal replacement therapy (IRRT) have been found. This systematic review appraised the literature for KPIs of IRRT in critically ill patients.

METHODS

Ovid MEDLINE, Ovid Embase, CINAHL, and Cochrane Library were searched for studies investigating KPIs for IRRT. Studies were included if they contained KPIs, occurred in critically ill patients, and were associated with IRRT. Risk of bias was evaluated using the modified Cochrane tool and the Newcastle-Ottawa Quality Assessment Scale. A descriptive analysis was performed. The KPIs were evaluated for importance, scientific acceptability, usability, and feasibility.

RESULTS

Our search yielded 7,726 citations, of which 240 fulfilled eligibility criteria. This included 201 (83.8%) observational studies, 28 (11.7%) randomized controlled studies, 4 (1.7%) case series, 4 (1.7%) economic modeling studies, and 3 (1.3%) case-controlled studies. The quality of retrieved studies was variable. A total of 11 different KPIs were mentioned in 673 instances. KPIs were classified as process (n = 5, 45.5%), outcome (n = 4, 36.3%), and structure (n = 2, 18.2%). The most commonly identified KPI was mortality (n = 166) followed by solute clearance (n = 105), intradialytic hypotension (n = 104), renal recovery (n = 79), ultrafiltration achieved (n = 60), adverse events (n = 53), filter/circuit clotting (n = 49), length of stay (n = 40), hemodynamic stability (n = 39), healthcare costs (n = 14), and organization structure and leadership (n = 4). Across studies, the definitions used for KPIs evaluating similar constructs varied considerably.

CONCLUSION

Eleven KPIs of IRRT care were identified. The heterogeneous definitions, differences in the quality of derivation, and insufficient evaluation were common characteristics. Further study is needed to define, classify, and prioritize a concise inventory of KPIs to measure, benchmark, and integrate their reporting into healthcare systems for IRRT care for critically ill patients.