Kellum John A, Mehta Ravindra L, Levin Adeera, Molitoris Bruce A, Warnock David G, Shah Sudhir V, Joannidis Michael, Ronco Claudio
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall, Room 608, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
Clin J Am Soc Nephrol. 2008 May;3(3):887-94. doi: 10.2215/CJN.04891107. Epub 2008 Jan 23.
Although acute kidney injury is common and significantly increases the risk for intensive care unit and hospital mortality, little is known about its true incidence or how it can be prevented. Furthermore, key unanswered questions remain about the optimal diagnosis and treatment of patients with acute kidney injury. An international, consensus-based, prioritized research agenda was sought to guide clinical and translational research in acute kidney injury.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A three-step modified Delphi process involving 43 participants representing 19 professional societies, organizations, and multiple stakeholder groups ranging from clinical practice to basic science research was conducted.
Twenty research questions were generated across six focus groups. Overall, research priorities generated from nephrologists and intensivists were similar and highly correlated. The stakeholder groups included members from 15 countries. Results from adult and pediatric groups showed important differences, as did results from developing compared with developed countries; however the priority rankings from the developed and developing countries were significantly correlated. Top research priorities in acute kidney injury include determining optimal timing of renal replacement therapy and improving the understanding of the epidemiology of acute kidney injury around the world.
Research recommendations that are highly consistent across various stakeholder groups and between developed and developing countries have been produced. It is hoped that these recommendations will prove valuable in guiding future clinical and translational research in this area.
尽管急性肾损伤很常见，且显著增加了重症监护病房及医院死亡率的风险，但对于其真实发病率以及如何预防却知之甚少。此外，关于急性肾损伤患者的最佳诊断与治疗仍存在关键的未解决问题。因此需要一个基于国际共识的优先研究议程来指导急性肾损伤的临床及转化研究。
设计、地点、参与者及测量方法：开展了一个经过三步修改的德尔菲法流程，涉及43名参与者，他们代表了19个专业协会、组织以及从临床实践到基础科学研究的多个利益相关者群体。
六个焦点小组共提出了20个研究问题。总体而言，肾病学家和重症监护医生提出的研究重点相似且高度相关。利益相关者群体包括来自15个国家的成员。成人组和儿科组的结果显示出重要差异，发展中国家与发达国家的结果也有所不同；然而，发达国家和发展中国家的优先排名显著相关。急性肾损伤的首要研究重点包括确定肾脏替代治疗的最佳时机以及增进对全球急性肾损伤流行病学的了解。
已经得出了在各利益相关者群体之间以及发达国家和发展中国家之间高度一致的研究建议。希望这些建议将证明对指导该领域未来的临床及转化研究具有价值。
