International survey on the management of acute kidney injury in critically ill patients: year 2007.

INTRODUCTION

Several aspects of acute kidney injury (AKI) management, including medical approaches to AKI patients and the optimal form of renal replacement therapy (RRT), remain a matter of debate.

SUBJECTS AND METHODS

The responses of 440 participants to a questionnaire on several points of AKI management, submitted during the 4th International Course on Critical Care Nephrology in June 2007, were analyzed.

RESULTS

The most common answer to the definition of AKI was the use of the RIFLE criteria (55%), followed by the presence of oligoanuria (24%). Responders seemed to preferentially start dialysis within a creatinine range from 2.3-3.4 mg/dl (28%) to 3.4-4.5 mg/dl (26%) and with a urine output level of 150-200 ml/12 h (43%). About 30% of responders showed that they would prescribe dialysis only in case of severe fluid overload (requiring mechanical ventilation and/or causing impaired skin integrity). Continuous RRT is used by most specialists (86%), followed by intermittent hemodialysis (65%), sustained low-efficiency dialysis (28%) and peritoneal dialysis (30%). The preferred RRT dosage was '35 ml/kg/h' (46%) but 37% of responders did not explicitly answer this critical question. Bleeding, hypotension, filter clotting, vascular access and sepsis treatment were the most frequent complications and concerns of RRT.

CONCLUSIONS

New classifications such as the RIFLE criteria did improve the well-known uncertainty about the definition of AKI. Awareness of the prescription and standardization of an adequate treatment dose seemed to have increased in recent years, even if there is still a significant level of uncertainty on this specific issue. Several concerns and RRT complications, such as bleeding and anticoagulation strategies, still need further exploration and development.