Defining and treating acute kidney injury patients in Brazilian intensive care units: Results from a cross-sectional nationwide survey

Abstract

Purpose: The purpose of the study is to characterize the practices of Brazilian intensivists toward acute kidney injury (AKI) definition and management.

Methods: A cross-sectional survey was conducted among 36 Brazilian hospitals.

Results: Of 731 ICU physicians invited to participate, 310 (42%) responded to the survey. Nearly half of the intensive care unit (ICU) physicians (146/310) do not apply AKIN and/or RIFLE definitions to their ICU patients. Most of the respondents prescribe intravenous fluids as a first-line therapeutic intervention for AKI patients. Although 38% of the surveyed physicians considered worsening of respiratory parameters to be the main criterion for stopping fluid infusion, only 15% considered daily net fluid balance as a criterion. Most of the respondents believed in the benefits of early renal replacement therapy (RRT) and considered worsening acidosis the most important criteria for starting early RRT. The main reason for a nephrologist referral was an urgently needed RRT.

Conclusions: Despite recent advances in AKI definition and management, most of the surveyed ICU physicians in Brazil have not incorporated them in their clinical practice. Important differences in the management of AKI patients were observed among Brazilian ICU physicians, which is relevant for educational interventions and future research.

Keywords: Acute kidney injury; Intensive care unit; Management; Renal insufficiency; Renal replacement therapy; Survey.