Renal replacement therapy in the ICU: The Australian experience

R. Bellomo, L. Cole, J. Reeves, W. Silvester

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)

Abstract

The structure of health care drives medical practice in a powerful way, shaping choices of therapy and approaches, and influencing scientific evidence. The Australian experience with continuous renal replacement therapy (CRRT) confirms the importance of structure. A public health system like that of Australia's contains the following variables: well-developed intensive care tradition and expertise, a dominant 'closed' intensive care unit (ICU) model, well-developed training of intensive care nurses with established one- to-one nurse-patient ratios, salaried medical practitioners, overworked general dialysis units with inadequate nursing resources, and lack of fee- for-service incentive for nephrologists to see ICU patients with acute renal failure. The likely outcome of such a system is for CRRT to be run by intensive care staff. As shown by a recent regional survey, this approach, although somewhat unique, is dominant and appears to work well with excellent clinical results and constant clinical research output.

Original languageEnglish
Pages (from-to)S80-S83
Number of pages4
JournalAmerican Journal of Kidney Diseases
Volume30
Issue number5 SUPPL.
DOIs
Publication statusPublished - 1 Jan 1997
Externally publishedYes

Keywords

  • Acute renal failure
  • Hemofiltration
  • Intensive care

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