• Olivier Ethgen, Alexander Zarbock, Jay L Koyner, Jorge Echeverri, Kai Harenski, Priyanka Priyanka, and John A Kellum.
• SERFAN Innovation, Namur, Belgium; Department of Public Health, Epidemiology & Health Economics, University of Liège, Liège, Belgium. Electronic address: o.ethgen@uliege.be.
• J Crit Care. 2022 Jun 1; 69: 153977.

BackgroundTiming 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.MethodsA 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.ResultsEarly 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).ConclusionsOur 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.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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