{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:02:16Z","timestamp":1785420136622,"version":"3.56.0"},"reference-count":20,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dong-A University Research Fund"},{"id":[{"id":"https:\/\/ror.org\/03qvtpc38","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: The utilization of renal replacement therapy (RRT) is crucial for the management of patients with acute kidney injury (AKI) in emergency departments (EDs). The prompt initiation of RRT, encompassing both intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT), is acknowledged as beneficial for critically ill patients. The purpose of this study is to investigate the implementation of RRT within EDs and its impact on ED length of stay (EDLOS) in South Korea. Methods: This retrospective study utilized data from the National Emergency Department Information System (NEDIS) for the year 2019 to assess the utilization of RRT in emergency medical centers (EMCs) across South Korea. The analysis focused on RRT, which includes intermittent HD and CRRT, as identified through insurance billing codes for patients treated during ED visits and subsequent admissions. EMCs were categorized into three groups based on the frequency of RRT sessions, and the median EDLOS was evaluated. Results: Among 5,937,569 ED visits to Level I and II emergency medical centers (EMCs), 40,130 cases (0.68%) received RRT. Of the 162 EMCs, 58 centers (35.8%) did not perform intermittent HD in the ED and 106 centers (65.4%) did not perform CRRT in the ED during the study period. Centers that frequently performed CRRT in the ED showed significantly longer EDLOS compared with centers that seldom or never performed CRRT (588 min [IQR 286\u2013767] vs. 270 min [IQR 147\u2013337] and 205 min [IQR 149\u2013363], respectively; p = 0.01). Regional disparities in the availability of ED-based RRT were also observed across South Korea. Conclusions: The frequency of RRT administration in EMCs in South Korea varied by region and facility. ED-based RRT utilization was associated with longer EDLOS, particularly in centers frequently performing CRRT. These findings suggest that patient acuity, institutional characteristics, and RRT-related resource utilization should be considered when evaluating EMC performance based on EDLOS.<\/jats:p>","DOI":"10.3390\/medicina62071273","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:41:38Z","timestamp":1782909698000},"page":"1273","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Utilization of Renal Replacement Therapy and Its Impact on the Emergency Department Length of Stay in South Korean Emergency Medical Centers"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7067-7899","authenticated-orcid":false,"given":"Ji Eun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Dong-A University Hospital, Twenty-Six Daesingongwon-Ro, Seo-Gu, Busan 49201, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1745-5127","authenticated-orcid":false,"given":"Jinwoo","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dong-A University Hospital, Twenty-Six Daesingongwon-Ro, Seo-Gu, Busan 49201, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1214-0820","authenticated-orcid":false,"given":"Yuri","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dong-A University Hospital, Twenty-Six Daesingongwon-Ro, Seo-Gu, Busan 49201, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Jun","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Ajou University Hospital, Suwon 16499, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute kidney injury","volume":"7","author":"Kellum","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1001\/jama.299.7.793","article-title":"Renal replacement therapy in patients with acute renal failure: A systematic review","volume":"299","author":"Pannu","year":"2008","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ccc.2016.12.003","article-title":"Renal replacement therapy in acute kidney injury: Controversies and consensus","volume":"33","author":"Heung","year":"2017","journal-title":"Crit. Care Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/sdi.12963","article-title":"Continuous renal replacement therapy and extended indications","volume":"34","author":"Ronco","year":"2021","journal-title":"Semin. Dial."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/1744-9987.13960","article-title":"Hemodialysis treatment for poisoning patients in the emergency department","volume":"27","author":"Orhan","year":"2023","journal-title":"Ther. Apher. Dial."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1056\/NEJMoa1803213","article-title":"Timing of renal-replacement therapy in patients with acute kidney injury and sepsis","volume":"379","author":"Barbar","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Morley, C., Unwin, M., Peterson, G.M., Stankovich, J., and Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0203316"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.emc.2019.04.006","article-title":"Emergency department management of acute kidney injury, electrolyte abnormalities, and renal replacement therapy in the critically ill","volume":"37","author":"Co","year":"2019","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e172","DOI":"10.3346\/jkms.2021.36.e172","article-title":"The prevalence and emergency department utilization of patients who underwent single and double inter-hospital transfers in the emergency department: A nationwide population-based study in Korea, 2016\u20132018","volume":"36","author":"Kim","year":"2021","journal-title":"J. Korean Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.3346\/jkms.2021.36.e111","article-title":"Impact of the COVID-19 outbreak on emergency care utilization in patients with acute myocardial infarction: A nationwide population-based study","volume":"36","author":"Sung","year":"2021","journal-title":"J. Korean Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lee, K.S., Min, H.S., Moon, J.Y., Lim, D., Kim, Y., Ko, E., Kim, Y.S., Kim, J., Lee, J., and Sung, H.K. (2022). Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: A nationwide analysis in Korea. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00745-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s13054-015-0850-8","article-title":"Renal replacement therapy in acute kidney injury: Controversy and consensus","volume":"19","author":"Ronco","year":"2015","journal-title":"Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s13063-015-0718-x","article-title":"Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: Study protocol for a randomized controlled trial (AKIKI)","volume":"16","author":"Gaudry","year":"2015","journal-title":"Trials"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1186\/s13063-019-3774-9","article-title":"The Artificial Kidney Initiation in Kidney Injury 2 (AKIKI2): Study protocol for a randomized controlled trial","volume":"20","author":"Gaudry","year":"2019","journal-title":"Trials"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.22537\/jksct.2023.00001","article-title":"Association between continuous renal replacement therapy and mortality after acute herbicide (glyphosate and\/or glufosinate) intoxication: Propensity score matching approach","volume":"21","author":"Lee","year":"2023","journal-title":"J. Korean Soc. Clin. Toxicol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"669","DOI":"10.4266\/acc.2021.00780","article-title":"Continuous renal replacement therapy increased plasma cholinesterase activity in a case of acute organophosphate poisoning","volume":"37","author":"Kwon","year":"2022","journal-title":"Acute Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"32","DOI":"10.12927\/hcq.2007.19312","article-title":"Frequency, determinants and impact of overcrowding in emergency departments in Canada: A national survey","volume":"10","author":"Bond","year":"2007","journal-title":"Healthc. Q."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2802","DOI":"10.12998\/wjcc.v8.i13.2802","article-title":"Correlation between crowdedness in emergency departments and anxiety in Chinese patients","volume":"8","author":"Wang","year":"2020","journal-title":"World J. Clin. Cases"},{"key":"ref_19","first-page":"26","article-title":"Latest data reveal the ED\u2019s role as hospital admission gatekeeper","volume":"38","author":"Augustine","year":"2019","journal-title":"ACEP Now"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/acem.14278","article-title":"Operational factors associated with emergency department patient satisfaction: Analysis of the Academy of Administrators of Emergency Medicine\/Association of Academic Chairs of Emergency Medicine national survey","volume":"28","author":"Reznek","year":"2021","journal-title":"Acad. Emerg. Med. Off. J. Soc. Acad. Emerg. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1273\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:23:16Z","timestamp":1782919396000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1273"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":20,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medicina62071273"],"URL":"https:\/\/doi.org\/10.3390\/medicina62071273","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}