Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.
TLDR
A 2-day consensus conference on acute renal failure (ARF) in critically ill patients was organized by ADQI as discussed by the authors, where the authors sought to review the available evidence, make recommendations and delineate key questions for future studies.Abstract:
There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at http://www.ADQI.net
) Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.read more
Citations
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KDIGO clinical practice guidelines for acute kidney injury.
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Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: The Acute Kidney Injury Network (AKI Network) as discussed by the authors is a multidisciplinary collaborative network focused on AKI, which was established to improve care for patients with or at risk for AKI.
Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: An initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI is described.
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Intensive insulin therapy in the medical ICU.
Greet Van den Berghe,Alexander Wilmer,Greet Hermans,Wouter Meersseman,Pieter Wouters,Ilse Milants,Eric Van Wijngaerden,Herman Bobbaers,Roger Bouillon +8 more
TL;DR: Intensive insulin therapy significantly reduced morbidity but not mortality among all patients in the medical ICU, and the risk of subsequent death and disease was reduced in patients treated for three or more days.
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Acute kidney injury
TL;DR: Evidence suggests that patients who have had acute kidney injury are at increased risk of subsequent chronic kidney disease, and new diagnostic techniques (eg, renal biomarkers) might help with early diagnosis.
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