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.