Variability in renal dysfunction defining criteria and detection methods in intensive care units: Are the international consensus criteria used for diagnosing renal dysfunction?

Abstract Objective To evaluate variability in the detection and prevention of acute kidney injury (AKI) in the intensive care unit (ICU), and application of the international recommendations in this field (Acute Dialysis Quality Initiative [ADQI] and Acute Kidney Injury Network [AKIN]). Design A prospective, observational, multicenter study. Setting A total of 42 ICUs in 32 hospitals (78% in third level hospitals and 70.7% general units) recruited for a study on the prevalence of AKI (COFRADE). Interventions Survey. Variables Aspects related to AKI detection and prevention and renal replacement therapy (RRT) protocols. Results The method used for estimating glomerular filtration rate was serum creatinine (Crs) in 36.6%, creatinine clearance in 41.5% and equations in 22%; none reported using cystatin-C. Only 39.1% ICUs acknowledged the use of stratification systems (13 RIFLE and 3 AKIN). A total of 48.8% ICUs had no written protocols for AKI prevention, 31.7% reported using them only for contrast nephropathy, 7.3% for nephrotoxic drugs and 12.2% for both. In contrast, 63.4% participants had written protocols for RRT, 70.7% had implemented a training program, and 53.7% had some method for adjusting doses of drugs when on RRT. Conclusions We observed an important variability regarding diagnostic criteria and prevention of AKI in Spanish ICUs, the application of ADQI or AKIN recommendations still being low in our units. RRT seems to generate more concern among our intensivists than AKI management.