Early versus delayed initiation of renal replacement therapy in cardiac-surgery associated acute kidney injury: an economic perspective

Background: Timing for renal replacement therapy (RRT) initiation for cardiac-surgery associated acute kidney surgery (CSA-AKI) is subject to debate. Evidence suggests earlier initiation leads to shorter length of stay (LoS). We investigated differences in healthcare costs associated with timing of RRT initiation in CSA-AKI. Methods: A cost-consequences model compared costs of Early (<24 h) vs. Delayed (>24 h) RRT initiation. Data were from the ELAIN trial in Germany, and the HiDenIC database, a US multi-hospital database. Resource utilization was determined by RRT duration, ICU, and hospital LoS. All resources were costed from a US healthcare perspective. Extensive sensitivity analyses (SA) were conducted, notably regarding the proportion of patients not initiated on RRT with the Delayed strategy. Results: Early RRT initiation exhibited cost savings compared to Delayed RRT initiation. With ELAIN data, savings reached-$122,188 (ranging from-$157,707 to-$74,763 in the SA). Findings were confirmed with HiDenIC data; Early RRT initiation showed savings of-$77,303 (ranging from-$108,971 to-$47,012 in the SA). Conclusions: Our costing model indicates that Early RRT initiation for CSA-AKI may result in appreciable cost savings. Delaying RRT, in the setting of CSA-AKI, may lead to longer LoS and increased healthcare costs. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://