RenalCurrent practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings
Introduction
Acute kidney injury (AKI) is an important and common problem in the intensive care unit (ICU). Worldwide prevalence of AKI in ICU ranges from 20%–70%, with a rate of renal replacement therapy (RRT) of 10% [[1], [2], [3]]. Regardless of clinical setting, AKI has been linked to increased morbidity and mortality.
After the introduction of Risk, Injury, Failure, Loss and End (RIFLE) criteria [4,5], Acute Kidney Injury Network (AKIN) criteria [6] and the latest, Kidney Disease Improving Global Outcomes (KDIGO) criteria [7], the definition and staging of AKI has become more standardized. Even though, these criteria are widely adopted in resource sufficient settings. Little is known about their use in resource limited settings [8].
Furthermore, there is still no adequate systemic data collection on which diagnostic investigations were devised in this specific setting. AKI greatly increases cost of medical care, therefore, gaining information regarding the diagnostic methods most commonly used will help provide a practical insight to better understand our practice of AKI management in resource limited settings.
Optimal management of AKI, especially RRT initiation in patients with advanced AKI stages will much decrease morbidity and mortality [9,10]. Many national surveys of current practice of RRT management were previously conducted in many countries such as Australia and New Zealand [11], UK [12], Europe [13], Japan [14] and Malaysia [15]. However, there are a few reports from resource limited settings.
This survey aimed to systematically collect data to reflect the current clinical management of AKI in hospitals across Thailand.
Section snippets
Survey and participants
To conduct this prospective study, we identified roughly 400 physicians who participated in the annual Thai nephrology conference and/or who were members of the Thai Nephrology Society between January and December 2014. We randomly selected 160 physicians who were involved in ICU practices and invited them to participate in our study by answering a questionnaire administered through online Survey Monkey or telephone interview.
Survey design
The 48 questions in the survey were mainly divided into the diagnosis
Results
The survey was distributed to 160 physicians involved in the critical care practices. One hundred and twenty-nine across 82 hospitals responded. We achieved a response rate 80.6% and cover 40% of Thailand hospitals with an ICU facility. Physicians were composed of nephrologists (69.0%), internists (22.0%), intensivists (7.8%), general practitioners (0.8%), and others (6.3%). The median age of survey participants was 36 (IQR 33–42) years. All levels of hospitals were included in our survey:
Discussion
Interestingly, the survey practice of AKI in resource limited countries may reveal different socioeconomic, environmental, and processes of care than in resource sufficient countries and may help to identify the important barriers. This, in turn, will help in the improvement AKI management which ultimately lead to better clinical outcomes. Our survey achieved in high response rate. Diagnosis of AKI was mostly defined by KDIGO criteria, and AKI assessment was mostly done through urinalysis
Conclusions
With increasing concern about current practice of AKI management in ICU, our study showed both the similarities and differences of AKI practice between resource limited settings and resource sufficient settings. It is noteworthy to emphasize that in Thailand, nephrologists play a major role in AKI management and that IHD is a main RRT modality. Our survey results may help provide insights into the current standard of care of AKI in resource limited settings and ultimately aims to guide the
Competing interests
The authors declare that they have no competing interests.
Acknowledgements
This study is a part of a project supported and funded by the Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross. We thank the staff, fellows, nurses and research coordinators at the Excellence Center for Critical Care Nephrology.
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