The European Society of Intensive Care Medicine endorsed the AKI-PURIFY survey, which gathered responses from 703 healthcare professionals involved in intensive care unit (ICU) care between February and April 2024.

The survey investigated various aspects of acute kidney injury (AKI) practices, including diagnostic strategies, the implementation of Kidney Disease: Improving Global Outcomes (KDIGO) preventive measures, renal replacement therapy practices, and barriers related to organization or education. Participants included intensivists, nephrologists, ICU consultants, fellows, nurses, and advanced practitioners from general, medical, cardiac, neurocritical, pediatric, and post-surgical ICUs.

Approximately one-third of the respondents indicated routine use of structured KDIGO preventive strategies. Fewer than half of the clinicians who answered a specific question about KDIGO strategies reported that these measures were regularly applied. The survey also found that the adoption of advanced AKI biomarkers remained limited overall.

Traditional urinalysis was utilized more frequently in lower-income settings and pediatric ICUs. Clinicians with more ICU experience and nephrologists reported higher utilization of diagnostic tools. The implementation of biomarker-guided prevention is restricted by cost, local availability, workflow integration, and uncertainty regarding cost-effectiveness, according to the survey results.

A correlation was observed between inadequate training and lower adoption rates of both urinalysis and KDIGO preventive strategies. Respondents from lower-middle and low-income countries reported higher rates of inadequate training and greater organizational barriers compared to their counterparts in high-income settings. Higher organizational barrier scores, which included the absence of ICU audit systems and difficulties in fluid balance management, were independently linked to lower implementation rates.

Why It Matters

Acute kidney injury affects nearly half of patients admitted to intensive care units. The AKI-PURIFY survey identifies specific challenges in implementing established preventive and diagnostic measures, pointing to potential disparities in care based on income levels and training access. Past research, such as the BigpAK-2 trial, has shown that structured preventive strategies can reduce moderate-to-severe AKI without increasing adverse events, suggesting that improved implementation could positively impact patient outcomes.