RENAL REPLACEMENT THERAPY IN THE ICU - THE AUSTRALIAN EXPERIENCE

The structure of health care drives medical practice in a powerful way , shaping choices of therapy and approaches, and influencing scientifi c evidence. The Australian experience with continuous renal replacemen t therapy (CRRT) confirms the importance of structure, A public health system like that of Australia's contains the following variables: wel l-developed intensive care tradition and expertise, a dominant ''close d'' intensive care unit (ICU) model, well-developed training of intens ive care nurses with established one-to-one nurse-patient ratios, sala ried medical practitioners, overworked general dialysis units with ina dequate nursing resources, and lack of fee-for-service incentive for n ephrologists to see ICU patients with acute renal failure, The likely outcome of such a system is for CRRT to be run by intensive care staff , As shown by a recent regional survey, this approach, although somewh at unique, is dominant and appears to work well with excellent clinica l results and constant clinical research output. (C) 1997 by the Natio nal Kidney Foundation, Inc.