Materials and methods
1. Proposal for uniform standards for definition and classification of AKI
Definition and diagnostic criteria of AKI
An abrupt (within 48 hours) reduction in kidney function currently defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (≥ 26.4 μmol/l), a percentage increase in serum creatinine of more than or equal to 50% (1.5-fold from baseline), or a reduction in urine output (documented oliguria of less than 0.5 ml/kg per hour for more than six hours).
Serum creatinine criteria
Urine output criteria
Increase in serum creatinine of more than or equal to 0.3 mg/dl (≥ 26.4 μmol/l) or increase to more than or equal to 150% to 200% (1.5- to 2-fold) from baseline
Less than 0.5 ml/kg per hour for more than 6 hours
Increase in serum creatinine to more than 200% to 300% (> 2- to 3-fold) from baseline
Less than 0.5 ml/kg per hour for more than 12 hours
Increase in serum creatinine to more than 300% (> 3-fold) from baseline (or serum creatinine of more than or equal to 4.0 mg/dl [≥ 354 μmol/l] with an acute increase of at least 0.5 mg/dl [44 μmol/l])
Less than 0.3 ml/kg per hour for 24 hours or anuria for 12 hours
2. Future joint conference topics and key collaborative research questions
Epidemiology of AKI
What is a 'nomenclature' that is based on simple, universally available data and that can identify all patients globally with AKI irrespective of location and age?
What are the data to help determine etiology once AKI is identified?
What are the correlates of AKI in regard to pathology/physiology?
Is there a validated method for assessing severity of AKI separate from multiple organ failure?
What is the relationship between degree of severity and outcomes?
Outcomes from AKI
What are the clinically meaningful outcomes that are important in clinical studies of AKI?
Strategies to change outcomes
Timing of initiation
Modality selection (CRRT, IHD, PD)
Intensity of therapy (dose)
Cessation of renal replacement therapy
Data needed to advance knowledge in AKI
Datasets collected at contact with health care system
Intensive care unit admission
Biological sample repositories
Measures of effectiveness of current processes for changing behavior/attitude of caregivers and ultimately patient outcomes from AKI.
3. Need for an international collaborative network
Principles and approach
Identify the key roles of the participating groups
a. The collaborative effort should be inclusive and open to all interested societies/organizations.
b. Participation in the collaborative organization will require commitment of time, expertise, and/or resources as appropriate to the specific initiative and in accordance with the means of the organization/group.
c. An organizational structure will be required to coordinate the activities.
d. Work products from the collaborative effort will require a mechanism for recognizing the contributions of each group.
Scope of collaborations
a. Identify topics in AKI areas of mutual interest and of wide application.
b. Develop consensus statements for best practice where there is limited or no evidence and where, due to accepted practices, it will be difficult to get evidence.
c. Develop tools to standardize the management of AKI.
d. Develop evidence through clinical research where feasible.
e. Develop practice recommendations/guidelines.
f. Implement guidelines.
Define infrastructure needs
a. Identify key components needed (for example, database, protocols for Web-based information transfer).
b. Establish the requirements for sharing information with regulatory agencies.
c. Define training needs for developing researchers and the resources that are required and define what hurdles will need to be overcome.
d. International collaboration will require identification of peer-reviewed, public, and commercial sources of financial support.
e. Develop an inventory of current collaborative efforts and establish relationships with these existing networks.
Identify common unifying principles that would form the basis of ongoing collaboration
a. Establish protocols for consistent data entry that allows benchmarking of participating units.
b. Identify questions that interest the majority of the participants.
c. Initiate a short-term collaborative project to validate proposed AKI definition as an initial project.
Interdisciplinary collaborative research network
Interim proposals for terminology, diagnosis, classification, and staging
Acute Dialysis Quality Initiative
Sudhir V Shah
Bruce A Molitoris
American Society of Pediatric Nephrologists
Emmanuel A Burdmann
European Dialysis and Transplant Association-European Renal Association
International Society of Nephrology
Ravindra L Mehta
International Society of Nephrology
David G Warnock
Indian Society of Nephrology
Asian Pacific Society of Nephrology
European Society of Intensive Care Medicine
Charles G Durbin Jr.
Society of Critical Care Medicine
Patrick SK Tan
Asia Pacific Association of Critical Care Medicine
American Thoracic Society
John A Kellum
American College of Chest Physicians
Jean-Roger Le Gall
Joseph V Bonventre
AKI is a complex disorder, and we have proposed uniform standards for diagnosing and classifying AKI on the basis of existing systems (that is, RIFLE). These proposals will require validation.
Our recommendations have been endorsed by participating societies that represent the majority of critical care and nephrology societies worldwide.
These recommendations provide a stepping stone to standardizing the care of patients with AKI and will greatly enhance our ability to design prospective studies to evaluate potential prevention and treatment strategies.
Future clinical and translational research in AKI will require the development of collaborative networks. The AKIN was formed to provide an effective mechanism for facilitating such efforts.