Article Data

  • Views 903
  • Dowloads 173

Original Research

Open Access

Is emergency renal replacement therapy in the emergency department as effective and safe as in the intensive care unit? A retrospective observational study

  • Du San Baek1
  • Tae Kyu Ahn1,*,†,
  • Soo Kang1,*,†,

1Department of Emergency medicine, Inha University College of Medicine, 22232 Incheon, Republic of Korea

DOI: 10.22514/sv.2023.003 Vol.19,Issue 6,November 2023 pp.30-37

Submitted: 15 June 2022 Accepted: 30 September 2022

Published: 08 November 2023

*Corresponding Author(s): Tae Kyu Ahn E-mail:
*Corresponding Author(s): Soo Kang E-mail:

† These authors contributed equally.


Patients needing renal replacement therapy (RRT) are usually admitted to the intensive care unit (ICU); however, due to limited beds in ICU, emergency RRT is often performed in the emergency department (ED). This study aimed to investigate whether emergency RRT performed in the ED is as effective and safe as in the ICU. This single-center retrospective observational study was conducted at a tertiary medical institution. Among patients who visited the ED from 01 March 2016, to 28 February 2021, the data of those who received RRT within 12 hours of visiting the ED were assessed. The patients were classified into an ICU and an ED group according to the location the first emergency dialysis was performed. In addition, a log-rank test was used to compare the survival rates of the ICU and ED groups. A total of 181 patients were included in this study, and there were no statistically significant differences between the demographic and clinical characteristics of the two groups. The proportion of patients with chronic kidney disease was higher in the ED group (p = 0.011), but there was no statistically significant difference in comorbidity rates of diabetes mellitus, hypertension, heart failure, coronary artery disease, and liver disease between the two groups. Additionally, no statistically significant difference was observed in the cumulative survival rate between the two groups (ICU group: 85.3% vs. ED group: 82.2%; p = 0.529). In conclusion, there was no difference in survival rate between patients who underwent emergency RRT in the ICU and ED and those who received emergency RRT in the ED, indicating that emergency RRT performed in the ED seems to be as effective and safe as in the ICU.


Intensive care unit; Emergency department; Renal replacement therapy; Cumulative survival rate

Cite and Share

Du San Baek,Tae Kyu Ahn,Soo Kang. Is emergency renal replacement therapy in the emergency department as effective and safe as in the intensive care unit? A retrospective observational study. Signa Vitae. 2023. 19(6);30-37.


[1] Brilli RJ, Spevetz A, Branson RD, Campbell GM, Cohen H, Dasta JF, et al. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Critical Care Medicine. 2001; 29: 2007–2019.

[2] Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, et al. What is an intensive care unit? A report of the task force of the world federation of societies of intensive and critical care medicine. Journal of Critical Care. 2017; 37: 270–276.

[3] Lyons RA, Wareham K, Hutchings HA, Major E, Ferguson B. Population requirement for adult critical-care beds: a prospective quantitative and qualitative study. The Lancet. 2000; 355: 595–598.

[4] Al-Qahtani S, Alsultan A, Haddad S, Alsaawi A, Alshehri M, Alsolamy S, et al. The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit. BMC Emergency Medicine. 2017; 17: 34.

[5] Hung S-C, Kung C-T, Hung C-W, Liu BM, Liu JW, Chew G, et al. Determining delayed admission to the intensive care unit for mechanically ventilated patients in the emergency department. Critical Care. 2014; 18: 485.

[6] Zhang Z, Bokhari F, Guo Y, Goyal H. Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission. Emergency Medicine Journal. 2019; 36: 82–87.

[7] Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, et al. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Critical Care. 2011; 15: R28.

[8] DELAY-ED study group; Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Critical Care Medicine. 2007; 35: 1477–1483.

[9] Liu SW, Thomas SH, Gordon JA, Hamedani AG, Weissman JS. A pilot study examining undesirable events among emergency department–boarded patients awaiting inpatient beds. Annals of Emergency Medicine. 2009; 54: 381–385.

[10] Rachoin JS, Weisberg LS. Renal replacement therapy in the ICU. Critical Care Medicine. 2019; 47: 715–721.

[11] Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Medicine. 2015; 41: 1411–1423.

[12] Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium poisoning. Journal of Intensive Care Medicine. 2017; 32: 249–263.

[13] Wang X, Jie Yuan W. Timing of initiation of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Renal Failure. 2012; 34: 396–402.

[14] Oh HJ, Shin DH, Lee MJ, Koo HM, Doh FM, Kim HR, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. Journal of Critical Care. 2012; 27: 743. e749–743. e718.

[15] Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. New England Journal of Medicine. 2018; 379: 1431–1442.

[16] Park JY, An JN, Jhee JH, Kim DK, Oh HJ, Kim S, et al. Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study. Critical Care. 2016; 20: 260.

[17] STARRT-AKI Investigators; Canadian Critical Care Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group; United Kingdom Critical Care Research Group; Canadian Nephrology Trials Network; Irish Critical Care Trials Group, Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, Dreyfuss D, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. New England Journal of Medicine. 2020; 383: 240–251.

[18] Kwak S-H, Jeong C-W, Lee S-H, Lee HJ, Koh Y. Current status of intensive care units registered as critical care subspecialty training hospitals in Korea. Journal of Korean Medical Science. 2014; 29: 431–437.

[19] Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine. 2008; 52: 126–136. e121.

[20] Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via western Australian emergency departments. Medical Journal of Australia. 2006; 184: 208–212.

[21] Carter AW, Pilcher D, Bailey M, Cameron P, Duke GJ, Cooper J. Is ED length of stay before ICU admission related to patient mortality?Emergency Medicine Australasia. 2010; 22: 145–150.

[22] Elmer J, Pallin DJ, Liu S, Pearson C, Chang Y, Camargo CA Jr, et al. Prolonged emergency department length of stay is not associated with worse outcomes in patients with intracerebral hemorrhage. Neurocritical Care. 2012; 17: 334–342.

[23] Park JS, Jang TC, Lee SH, Ko SH, Lee KW, Kim GM, et al. Effects of emergency doctor’s hospitalization authority from internal medicine and utilizing emergency ward on length of stay in emergency department. Journal of The Korean Society of Emergency Medicine. 2022; 33: 271–278.

[24] Choi Y, Jeong J, Kim B-G. Admission decisions made by emergency physicians can reduce the emergency department length of stay for medical patients. Emergency Medicine International. 2020; 2020: 1–6.

[25] Yoon C-H, Myung SJ, Park WB. Implementing competency-based medical education in internal medicine residency training program: the process and impact on residents’ satisfaction. Journal of Korean Medical Science. 2019; 34: e201.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time