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Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group

Rinaldo Bellomo1*, Claudio Ronco2, John A Kellum3, Ravindra L Mehta4, Paul Palevsky5 and the ADQI workgroup6

Author Affiliations

1 Department of Intensive Care and Medicine, Austin Health, Melbourne, Australia

2 Department of Nephrology, San Bortolo Hospital, Vicenza, Italy

3 Departments of Critical Care Medicine and Medicine, University of Pittsburgh Medical Center, and Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA

4 Department of Medicine, University of California, San Diego, California, USA

5 Department of Medicine, University of Pittsburgh Medical Center, and Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA

6 For a complete list of authors, see Appendix 1

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Critical Care 2004, 8:R204-R212  doi:10.1186/cc2872


See related letters by Lopes et al., http://ccforum.com/content/11/1/401 and Englberger et al., http://ccforum.com/content/13/6/429

Published: 24 May 2004

Abstract

Introduction

There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies.

Methods

We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research.

Results

We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at http://www.ADQI.net webcite)

Conclusion

Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.

Keywords:
acute renal failure; animal models; creatinine; glomerular filtration rate; information technology; intravenous fluids; kidney; outcome research; randomized controlled trials; urea