Consensus development in acute renal failure: the Acute... : Current Opinion in Critical Care (original) (raw)

Renal system

Consensus development in acute renal failure: the Acute Dialysis Quality Initiative

Kellum, John Aa; Ronco, Claudiob; Mehta, Ravindrac; Bellomo, Rinaldod

aDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; bDepartment of Nephrology, St Bortolo Hospital, Vicenza, Italy; cDivision of Nephrology, University of California at San Diego, San Diego, California, USA; and dDepartment of Intensive Care, Austin Hospital, Melbourne, Australia

Correspondence to John A. Kellum, MD, Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA

Tel: 412 647 6966; fax: 412 647 3791; e-mail: [email protected]

Abstract

Purpose of review

Although acute renal failure is both common and highly lethal in the intensive care unit, our understanding of the epidemiology and pathophysiology of acute renal failure is limited, and treatment for acute renal failure is extremely variable around the world. The general lack of consensus with regard to definitions, prevention, and treatment of acute renal failure has limited progress in this field.

Recent findings

Consensus in acute renal failure requires establishing a framework in which intensivists, nephrologists, pharmacologists, and others who care for critically ill patients with or at risk for acute renal failure can reach consensus and develop evidence-based practice guidelines. The Acute Dialysis Quality Initiative seeks to provide an objective, dispassionate distillation of the literature and description of the current state of practice of dialysis and related therapies as they are applied to acutely ill patients. The purposes of Acute Dialysis Quality Initiative are first, to develop a consensus of opinion, with evidence where possible, on best practice; and second, to articulate a research agenda to focus on important unanswered questions.

Summary

Broad consensus in the diagnosis and management of acute renal failure and in the use of blood purification in nonrenal critical illness is achievable. Standardization of definitions, practice, and research methodology is urgently needed, and specific proposals have been made by an international, interdisciplinary group.