A recent survey endorsed by the European Society of Intensive Care Medicine found that preventive strategies for acute kidney injury are inconsistently implemented across intensive care units worldwide, according to a July 3 report. Acute kidney injury affects nearly half of critically ill patients admitted to ICUs and is linked with longer hospital stays, increased healthcare costs, long-term dysfunction, and higher mortality.
The AKI-PURIFY survey was conducted between February and April 2024 and gathered responses from 703 healthcare professionals in various ICU settings across multiple countries. Participants included intensivists, nephrologists, consultants, fellows, nurses, and advanced practitioners working in general medical, cardiac, neurocritical, pediatric, and post-surgical ICUs.
The survey examined four main areas: diagnostic strategies for acute kidney injury (AKI), implementation of Kidney Disease: Improving Global Outcomes (KDIGO) preventive measures, renal replacement therapy practices, and organizational or educational barriers affecting care delivery. Results showed substantial variability in all domains. Only about one-third of respondents reported routinely implementing structured KDIGO preventive strategies despite strong evidence supporting their effectiveness. Fewer than half stated that these measures were regularly applied even among those who answered questions specifically about KDIGO guidelines.
The findings also indicated differences in diagnostic approaches based on setting and experience level. Traditional urinalysis was more common in lower-income settings and pediatric ICUs, while use of advanced biomarkers remained limited overall. Nephrologists and clinicians with greater ICU experience reported higher use of diagnostic tools. Barriers such as cost concerns, local availability issues, workflow integration challenges, and uncertainty over cost-effectiveness limited broader adoption.
Educational gaps emerged as a significant factor influencing practice patterns; clinicians with inadequate training were less likely to use urinalysis or implement KDIGO recommendations. Organizational obstacles—including lack of audit systems or challenges managing fluid balance—were also associated with lower uptake rates for recommended practices. Respondents from lower-middle- and low-income countries reported higher rates of inadequate training along with greater organizational barriers compared to those from high-income settings.
The AKI-PURIFY survey concludes that translating evidence-based guidelines into routine clinical practice remains a challenge worldwide despite advances in research on AKI prevention. The authors say sustainable improvement will require coordinated education efforts alongside institutional support systems.
