AKI-EPI-2
Acute Kidney Injury – Epidemiology in ICU patients – 2 (AKI-EPI-2): An International Cohort Study
Objectives
The AKI-EPI-2 will aim to:
- Provide a contemporary update on the epidemiology (rates, severity, duration and etiology) of AKI and associated outcomes in critically ill patients.
- Assess temporal aspects of AKI (timing relative to ICU admission and duration).
- Describe RRT practices (indications, timing, modality, anticoagulation, dose, duration, and discontinuation).
- Explore differences in rates and outcomes between regions and health care systems according to geographical location and resources.
Detailed Description
Acute Kidney Injury (AKI) is a frequent complication in critically ill patients admitted to the intensive care unit (ICU). In several large epidemiological studies, the occurrence of AKI during the first 5-7 days of ICU admission ranges between 40-60%. The reported incidence and association with outcomes in these studies were highly heterogeneous, plausibly partly driven by important differences across geographical location and socio-economic status.
Although of major importance to the field, these studies have limitations. First, these studies were performed more than a decade ago. More recently, numerous changes in practice have occurred regarding AKI management. For instance, the impact of standardized evidence-based care bundles for AKI have shown benefit in selected populations. Similarly, several clinical trials have shown no survival benefit for patients receiving an early strategy for initiation of renal replacement therapy (RRT). The number of elderly patients admitted to the hospital and for whom invasive procedures are proposed have also increased over time, implying a changing demographic and clinical profile in patients susceptible to AKI. Altogether, these elements are likely to have modified the incidence and outcomes of AKI in critically ill patients. Second, recent consensus guidance has proposed the integration of newer diagnostic tests (e.g., biomarkers) of kidney damage into the definition of AKI. The utilization of such biomarkers is also likely to have modified our ability to assess kidney injury and apply protective measures. Third, prior large epidemiological studies did not evaluate the impact of AKI duration (or magnitude) on outcomes 90-days after ICU admission (the current gold standard to define chronic kidney disease). Fourth, these studies also did not describe the utilization and practice of acute renal replacement therapy (RRT) in critically ill patients with AKI. Finally, in these studies, there was under-representation of low- and middle-income countries.
Accordingly, there is strong rationale for an updated global snapshot of the epidemiology of AKI in critically ill patients. The AKI-EPI-2 study, an international multicenter observational study, has been specifically designed with this objective in mind.
Design
This is an international multicentre observational cohort study. Data will be collected at baseline (ICU admission) and daily during ICU admission for days 1 through 7 (or ICU discharge, whichever occurs first). Outcome data will be collected at hospital discharge and, where permitted, long-term outcome data will be collected at 90-days and 1-year.
Study Population
The AKI-EPI-2 study will recruit consecutive critically ill patients admitted to ICU fulfilling eligibility criteria. Recruitment will accrue until the target enrollment for sites and the overall study is achieved (target enrollment ~10,642). The duration of the study period may vary from center to center.
For Contact and Location information please click here.
AKI-EPI-2 Updates and Announcements
- AKI-EPI-2 (North America) received funding support from Baxter via the Investigator Initiated Research (IIR) grant program.