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A Mixed-Methods Assessment of Health Care Professionals’ Perspectives on CRRT Delivery and Opportunities for Improvement

Year: 2026

Type: article

Abstract: Rationale & Objective: Continuous renal replacement therapy (CRRT) is the preferred dialysis modality for critically ill patients with acute kidney injury, yet its delivery and quality vary across institutions. This study aimed to identify gaps in CRRT practice and explore strategies to improve CRRT delivery from the perspective of multidisciplinary health care professionals. Study Design: Convergent parallel mixed methods. Setting & Participants: This study was conducted during the 2024 CRRT Academy and included multidisciplinary participants comprising trainees (residents and fellows), clinicians (nephrologists and intensivists), clinical staff (nurses, nurse practitioners, and pharmacists), and industry/research affiliates. Analytical Approach: Quantitative data were collected using a survey assessing CRRT practices, standardization, and collection of quality metrics. Qualitative data were obtained through 5 semistructured focus group discussions (4 with participants and 1 with CRRT Academy faculty) and were analyzed using a combined inductive-deductive thematic approach in NVivo 15. Results: There were 83 participants: 54 trainees, 19 clinicians, 8 clinical staff, and 2 industry/research affiliates, with 10-24 participants in each focus group. The following 4 key themes were identified as relevant to improve CRRT delivery from participant focus groups: (1) teamwork and multidisciplinary communication, (2) collection and tracking of CRRT-relevant metrics, (3) protocol standardization while allowing flexibility to individualize care, and (4) education for clinicians and clinical staff. The faculty focus group emphasized the need for institutional financial support and leadership-driven quality improvement (QI) initiatives, highlighting the importance of nephrologist advocacy. Participants reported significant variability in CRRT processes, QI data collection, and education across institutions, with limited adoption of CRRT key performance indicators owing to lack of consensus and workflow integration challenges. Limitations: Participants primarily represented academic centers and the majority were trainees, which may limit generalizability of the findings. However, given the paucity of mixed-methods evidence about current CRRT practice, this study provides novel insights that can help advance standardization. Conclusions: This study underscores key areas for improving CRRT delivery, including interprofessional collaboration, data-driven QI, protocol standardization, and targeted education. Addressing these themes may help improve CRRT processes of care and patient-centered outcomes.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2026.101531