Table 2 |.
Research priorities and questions for investigation in AKI
| Diagnostics |
| 1. Evaluate the clinical applicability of real-time or kinetic GFR. |
| 2. Determine the magnitude of change in serum creatinine concentration that indicates AKI. |
| 3. Explore how differences in body composition (e.g., overweight, fluid overload) affect urine output, and whether these differences need to be considered regarding the thresholds for AKI. |
| Risk stratification |
| 1. Conduct multicenter studies for external validation of AKI risk models as well as standardization and correlation with outcomes. |
| 2. Define the role of kidney biopsy in managing AKI. |
| 3. Identify additional endpoints (beyond mortality, chronic kidney disease, and dialysis dependency) for both clinical management and trials. These could include recovery of function, continued need for dialysis, maximum changes in creatinine concentration, stage of AKI, functional renal reserve, biomarkers, and patient experience assessment (patient-reported outcome measures and patient-reported experience measures). |
| 4. Develop a more accurate definition of recovery and its functional (i.e., filtration, tubular, endocrine) and anatomic/structural dimensions. |
| Fluid management and hemodynamic support |
| 1. Determine the optimal indications and targets for fluid and vasoactive drugs to improve kidney outcomes in acute medical illness and in the perioperative setting. |
| 2. Determine the optimal vasopressor in this context and explore how the indications and targets should be translated to and from resource-limited settings. |
| 3. Investigate the optimal method of administering fluid for preventing or mitigating AKI (route [oral or i.v.]; bolus versus continuous; and rate, volume, and frequency of boluses) and explore whether the optimal methods vary in different contexts where different levels of monitoring are available, including pre-hospital settings and resource-limited settings. |
| 4. Investigate new techniques to detect fluid overload in adults and from this define fluid overload thresholds to guide management decisions; in addition, determine how fluid removal should be optimally accomplished including method, rate, targets, and monitoring. |
| 5. Investigate if there is a confirmed hazard from the use of 0.9% saline compared with balanced solutions on kidney outcomes in adults and identify the mechanism and explore whether there are any subgroups at particular risk. |
| 6. Explore the role for sodium bicarbonate in patients with AKI and metabolic acidosis. |
| Nephrotoxic agents and drugs that affect kidney function |
| 1. Investigate whether biomarkers for risk prediction, surveillance, or diagnostic evaluation (to discriminate between kidney dysfunction and injury) can affect choice of treatment strategy. |
| 2. Determine the role of electronic clinical decision-support systems to proactively identify risk and injury from drugs. |
| 3. Undertake drug burden assessment to determine which nephrotoxic drugs and drug combinations are associated with increasing risk for dysfunction and injury. |
| 4. Conduct studies to guide timing of ACE-I/ARBs discontinuation and re-initiation in AKI/AKD in different clinical contexts such as heart failure, surgery, and sepsis. |
| 5. Undertake research on the role of statins in preventing contrast-associated AKI in stable and acute settings, and study the dose-dependence of effect. |
| RRT |
| 1. Investigate the optimal timing, dose, and modality of RRT and identify the indicators that predict successful discontinuation of RRT. |
| 2. Compare different methods of assessing fluid removal goals and rates of fluid removal with RRT. |
| 3. Develop a registry focused on patients receiving ECLS-RRT. |
| 4. Develop a registry of patients receiving combined ECMO/ECCO2R and RRT. |
| 5. Evaluate whether ECCO2R can be efficiently applied in a system combining RRT and ECCO2R. |
| 6. Conduct clinical studies on respiratory dialysis (ECCO2R and ECMO) with modified dialysis solutions. |
| 7. Compare anticoagulation strategies (including citrate) of the RRT circuit during ECMO/ECCO2R. |
ACE-I, angiotensin-converting enzyme inhibitors; AKD, acute kidney diseases and disorders; AKI, acute kidney injury; ARB, angiotensin-receptor blockers; ECCO2R, extracorporeal carbon dioxide removal; ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygenation; GFR, glomerular filtration rate; RRT, renal replacement therapy.