Acute Care/Hospitalization

Daily hemodialysis is cost-effective for intensive care patients with acute kidney injury

Intensive care patients with acute kidney problems live up to 2 years longer when toxins are removed from their blood with hemodialysis daily instead of every other day. Daily hemodialysis is also more cost-effective, concludes a new economic study that draws on findings from a 2002 clinical trial to compare costs and effectiveness of the two dialysis regimens. Patients receiving daily hemodialysis for acute kidney injury (AKI) were projected to live longer with good quality of life than patients treated every other day.

The additional cost for the more intensive treatment was $10,924, or $5,084 per quality-adjusted life year. The frequency of AKI is rising for patients in intensive care units (ICUs), straining the health care system's allocation of resources for dialysis. Intensive care unit patients often develop AKI due to trauma, surgery, or illness. Optimal timing, modality, dose, and frequency of hemodialysis has not yet been established. The researchers used data from the clinical trial to develop a model for comparing the cost of quality-adjusted life years for patients treated with each regimen in the hospital ICU. The model used in the study assumed that the advantage of daily dialysis only lasted for the period of hospitalization. The overall costs could increase greatly if the additional patients who survived because of daily inpatient hemodialysis went on to develop chronic kidney disease requiring outpatient treatment, they note.

Future studies that divide the ICU patients according to the severity of their AKI may help identify a particular subgroup of patients to whom daily hemodialysis should be targeted, according to the researchers. They conclude that daily hemodialysis provides a cost-effective option for managing AKI in critically ill patients-an option that can be readily implemented in most hospitals that already provide inpatient hemodialysis services.

The study was funded in part by the Agency for Healthcare Research and Quality training grant (T32 HS00028). More details are in "Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs. alternate-day hemodialysis," by Amar A. Desai, M.D., M.P.H., Jacqueline Baras, B.A., Benjamin B. Berk, M.D., M.S., and others in the September 8, 2008, Archives of Internal Medicine 168(16), pp. 1761-1767.

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