Continuous veno-venous hemofiltration (CVVH) is commonly used as kidney replacement therapy for critically ill patients with acute kidney injury (AKI), particularly in those with hemodynamic instability. Excessive filtration fraction (FF) may promote hemoconcentration, filter clotting, and premature circuit failure; therefore, maintaining FF within the recommended range, generally below 20–25%, is an important component of high-quality CVVH prescription. Although electronic calculators may support bedside prescription adjustment, the clinical utility of integrating an FF calculator directly into the electronic order system has not been fully evaluated.

We conducted a retrospective cohort study using the health information system database of a single tertiary medical center. All CVVH sessions performed in intensive care units between January 1, 2019, and December 31, 2021, were screened. A built-in FF calculator was incorporated into the electronic CVVH prescription system on October 1, 2020. CVVH sessions were therefore categorized into a pre-implementation group and a post-implementation group according to the date of calculator introduction. The main outcomes included circuit clotting events, filter lifespan, ICU mortality, and estimated treatment cost per CVVH session.

A total of 868 ICU CVVH sessions were identified. After excluding sessions involving patients younger than 20 years of age, patients with HIV infection, and sessions with missing data, 791 CVVH sessions from 469 patients were included in the final analysis. Compared with the pre-implementation group, the post-implementation group had significantly lower 14-day and 30-day ICU mortality rates (p=0.010 and p=0.028, respectively). Implementation of the built-in FF calculator was also associated with an approximately 10% reduction in circuit clotting events (p=0.011), and a 5-hour increase in filter lifespan (p<0.001).

In this large retrospective cohort of critically ill AKI patients receiving CVVH, integration of a built-in FF calculator into the electronic prescription system was associated with improved treatment quality, fewer clotting events, longer filter lifespan, lower treatment cost, and better ICU survival. These findings support the use of automated prescription-support tools to optimize CVVH delivery in real-world critical care settings. Part of these results was previously presented at the Taiwan Society of Nephrology meeting in 2022.