International Survey on the Management of Acute Kidney Injury and Continuous Renal Replacement Therapies: Year 2018

Abstract

Introduction: Definition, prevention, and management of acute kidney injury (AKI) and the optimal prescription and delivery of renal replacement therapy (RRT) are currently matters of ongoing discussion. Due to the lack of definitive published literature, a wide gap might exist between routine clinical practice and available recommendations. The aim of this survey was to explore the clinical approach to AKI and RRT in a broad population of nephrologists and intensivists participating in the 36th International course on AKI and Continuous RRT (CRRT), held in Vicenza in June 2018. The responses of the 369 participants to a questionnaire on several aspects of critical care nephrology were analyzed and detailed. Results: Approximately 450 participants attended the course; of these, 369 (82%) correctly filled the survey forms. According to the reported answers, the average incidence of AKI in respondents’ intensive care units (ICU) was 26.8% (SD ±15.99) and AKI requiring dialysis was 13% (SD ±29.7). Sixty-four percent of participants defined AKI as an increase in serum creatinine (SCr) up to 0.99 mg/dL (SD ±0.88 mg/dL); 2.4% defined AKI as an increase in urea nitrogen up to 83.6 mg/dL (SD ±36.6 mg/dL); 33.6% defined AKI as decreased urine output to less than 1 mL/kg/h (SD ±0.6 mL/kg/h). The most common answer to classify AKI was Kidney Disease: Improving Global Outcomes (KDIGO; 41%) criteria. Most of the participants (25%) think novel biomarkers should replace SCr on daily routine laboratory screening, and Cystatin C was the most commonly used biomarker (19%). The use of diuretics in AKI patients was high (62%). Continuous RRT (59%) and heparin anticoagulation (42%) appeared to be the most common approaches in ICU. Conclusions: KDIGO appeared to be widely applied. The use of novel biomarkers has also emerged in recent years even if some consistent cost-benefit evidence is still lacking. There is a trend of increased awareness about AKI and extracorporeal treatments seem to be increasingly applied, when compared to previous surveys. Educational efforts and AKI management standardization still appear to be a fundamental aspect to harmonize therapeutic approaches and improve patients’ outcomes.

How and when do we use continuous renal replacement therapy for acute kidney injury in Serbia? - The multicentric survey

“…Our subjects use almost equally high (≥250 mg/day) and low doses of Furosemide (≤250 mg/day) in the conservative treatment of AKI, and a relatively equal representation in the range of up to 30.0% of AKI patients requiring CRRT is reported. These results are different from last year's study in which it was stated that most use high doses in oligurian patients and that 13.0% of patients require CRRT (5). In our institutions, most respondents stated that they use the KDIGO 2 criterion for "early" start of CRRT, and for already present complications associated with AKI or poor response to conservative therapy, participants start CRRT "late".…”

“…Over the past year, 33% reported that 21-40% of the patients had "early" onset CRRT recovery in renal function and 46.8% said that less than 5.0% of the patients had died, as opposed to "late" CRRT onset which reported an increase in renal function <5.0% out of 44.7% of the participants, whereas 40.4% reported death in 5.0%-20% of the patients (Table 1). According to the results, slightly more than half of the participants still use the RIFLE criteria to define the AKI, while in terms of representation, the following use the KDIGO criteria, which is different from the results published last year, in which the KDIGO criteria are dominant (5). The higher prevalence of the RIFLE classification has been reported in previous studies, and in our sample it can be explained by the participation of nonnephrological specialty respondents and possibly by a high percentage of physicians with many years of experience who are somewhat skeptic about accepting novelties (6,7).…”

Continuous Renal Replacement Therapy Without Anticoagulation: Top Ten Tips to Prevent Clotting

“…However, data from practice surveys in 2014 and 2018 indicate heparin was commonly used for CRRT as the anticoagulant of choice [19,20] (83-42%, respectively) but is possibly reducing in favor of citrate and will be compared further in a proposed 1,450 patient, randomized controlled trial in Germany [18].…”

Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

“…Eine systemische Antikoagulation ist bei kontinuierlichen Nierenersatzverfahren in aller Regel notwendig. Als Standard gilt unfraktioniertes Heparin [233,234]. Die gerinnungshemmende Wirkung wird dabei hauptsächlich über Bindung an Antithrombin induziert.…”