Continuous renal replacement therapy (CRRT) is a complex and highly specialized modality that requires close monitoring to ensure patient safety and treatment efficacy. Although standardized key performance indicators (KPIs) are essential for assessing and improving CRRT quality, formal guidance on CRRT quality measures remains limited. This study aimed to compare institutional CRRT performance with the proposed quality and performance measures in the 2026 KDIGO AKI/AKD public review draft and to identify key areas for quality improvement.

This retrospective observational study included critically ill adult patients who received CRRT at Thammasat University Hospital, Thailand. Clinical data, patient demographics, and operational CRRT parameters were collected. Key quality measures encompassing structural components (leadership, education), operational efficiency (time to initiation, filter lifespan, downtime), and clinical delivery (dose intensity, ultrafiltration, complications) were evaluated against established standard benchmarks.

A total of 106 CRRT treatments were evaluated. The mean age was 63.4 ± 15.3 years, 38 patients (38.9%) were male, and 49 patients (46.2%) were admitted to the medical ICU. Structural indicators were fully achieved, with 100% CRRT leadership and provider training. Most operational metrics met proposed benchmarks, including time to CRRT initiation of 1.53 hours (<3 hours), downtime of 12.3% (<15%), and unplanned filter changes of 14.2% (<50%). Access alarms were low at 0.05 ± 0.21 alarms/CRRT-day (<3 alarms/CRRT-day). Treatment delivery was adequate, with a delivered-to-prescribed dose ratio of 97 ± 6% (>80%), recommended dose delivery in 100% of treatments (>85%), and ultrafiltration achievement of 89.6% (80.3–101%; >85%). Adverse events were infrequent at 0.18 ± 0.39 events/CRRT-day (<1 event/CRRT-day). However, filter lifespan was slightly below target at 45.7 hours (>48 hours), and ICU survival was low at 31.1% (>50%).

This study is among the first to evaluate CRRT quality performance using the proposed measures from the 2026 KDIGO AKI/AKD public review draft. Most structural, operational, treatment delivery, and safety indicators met proposed benchmarks. However, filter lifespan and ICU survival remained below target and should be prioritized for future quality improvement.