Dialyzing Wisely - Improving the Delivery of Acute Renal Replacement Therapy to Albertans

Implementation of an evidence-based and best practices acute RRT pathway aiming to decrease acute RRT program and healthcare systems costs while improving important patient-reported outcomes.

Study Overview

• Status: Recruiting
• Conditions: Acute Renal Injury
• Intervention / Treatment: Other: KPI reports; Other: Prescriber reports

Detailed Description

Providing acute dialysis to critically ill patients in ICU settings is resource and cost intensive. The daily costs of acute dialysis can range from $528/day for intermittent hemodialysis to $865/day for continuous renal replacement therapy. Providing acute dialysis in ICU settings requires a specialized team of nurses, educators, physicians and stakeholders to ensure its safe and effective prescription and delivery. Acute dialysis is typically delivered to some of the most acutely ill patients admitted to the ICU to support organ function and sustain life.

At present, there is not a standardized approach to the prescription and delivery of acute dialysis therapy in ICUs across Alberta. The DIALYZING WISELY program will implement a standardized approach to the delivery of best practices for acute dialysis therapy to all patients who receive treatment across ICUs in Alberta.

• Study Type: Observational
• Enrollment (Estimated): 4500

Contacts and Locations

• Study Contact: Name: Dawn Opgenorth, RN; Phone Number: 780 492-4698; Email: dawno@ualberta.ca
• Study Contact Backup: Name: Oleksa Rewa, MD; Email: rewa@ualberta.ca

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2N 2T9
      • Not yet recruiting
      • Foothills Medical Centre
      • Contact: Oleksa Rewa, MD; Phone Number: 780-231-3280; Email: rewa@ualberta.ca
    • Calgary, Alberta, Canada, T1Y 6J4
      • Not yet recruiting
      • Peter Lougheed Centre
      • Contact: Oleksa Rewa, MD; Phone Number: 780-231-3280; Email: rewa@ualberta.ca
    • Edmonton, Alberta, Canada, T6G-2B7
      • Recruiting
      • University of Alberta Hospital
      • Contact: Oleksa Rewa, MD; Phone Number: 780-231-3280; Email: rewa@ualberta.ca
    • Red Deer, Alberta, Canada, T4N 4E7
      • Not yet recruiting
      • Red Deer Regional Hospital Centre
      • Contact: Oleksa Rewa, MD; Phone Number: 780-231-3280; Email: rewa@ualberta.ca
    • St. Albert, Alberta, Canada, T8N 6C4
      • Recruiting
      • Sturgeon Community Hospital
      • Contact: Oleksa Rewa, MD; Phone Number: 780-231-3280; Email: rewa@ualberta.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

All patients from 15 adult and 3 pediatric Alberta ICUs who receive acute RRT as part of their usual clinical care during the intervention period

Description

Inclusion Criteria:

Patient in one of 15 adult and 3 pediatric intensive care units in Alberta Receive acute RRT as part of their usual clinical care during the intervention period

Exclusion Criteria:

• none

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
ICU patients receiving renal replacement therapy; All patients in participating ICU's receiving CRRT or IRRT during the study period	Other: KPI reports; Quarterly; Other Names: Monitoring, reporting and regular review of acute RRT KPIs; Other: Prescriber reports; Individualized prescriber reports for acute RRT initiation patterns along with targeted education to ensure that align with best evidence-based practices

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Key performance indicators (KPI)	Changes in acute KPIs	Throughout intervention period up to 3 years
Health system costs	Acute RRT and healthcare systems costs	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of renal replacement therapy	Length of time patient receives RRT during their ICU stay	3 years
ICU and hospital lengths of stay	Number of days patient spends in the ICU and hospital	3 years
ICU and 90 day mortality	number of patients who die before ICU discharge or within 90 days of ICU stay	3 years
Rates of RRT dependence at 90 days	number of patients who are receiving RRT at 90 days after ICU stay	3 years

Collaborators and Investigators

• Sponsor: University of Alberta
• Collaborators: Alberta Innovates Health Solutions
• Investigators: Principal Investigator: Oleksa Rewa, MD, University of Alberta

Publications and helpful links

General Publications

• Opgenorth D, Bagshaw SM, Lau V, Graham MM, Fraser N, Klarenbach S, Morrin L, Norris C, Pannu N, Sinnadurai S, Valaire S, Wang X, Rewa OG. A study protocol for improving the delivery of acute kidney replacement therapy (KRT) to critically ill patients in Alberta - DIALYZING WISELY. BMC Nephrol. 2022 Nov 16;23(1):369. doi: 10.1186/s12882-022-02990-6.

Study record dates

Study Major Dates

• Study Start (Actual): January 12, 2023
• Primary Completion (Estimated): December 31, 2024
• Study Completion (Estimated): June 30, 2025

Study Registration Dates

• First Submitted: December 9, 2021
• First Submitted That Met QC Criteria: December 23, 2021
• First Posted (Actual): January 11, 2022

Study Record Updates

• Last Update Posted (Actual): October 11, 2023
• Last Update Submitted That Met QC Criteria: October 9, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: quality improvement; critical care medicine; evidence based care pathway,; acute renal replacement therapy
• Additional Relevant MeSH Terms: Kidney Diseases; Urologic Diseases; Renal Insufficiency; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Acute Kidney Injury
• Other Study ID Numbers: Pro00112499

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No