#5292 BRAZILIAN SURVEY ON THE MANAGEMENT OF ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPIES
Authors: Teixeira Mauricio , Coelho Fernanda , Passos Rogério , Lopes Marcelo , Silveira Marcelo , Reis Thiago , Zawadzki Bruno 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) diagnosis, management, the optimal prescription and delivery of renal replacement therapy (RRT) standards for best practice are lacking. The aim of this study was to explore the clinical approach to AKI and RRT in a broad population of Brazilian nephrologists.

Method
A cross-sectional survey was distributed to all nephrologists from multiple centres of a Brazilian private hospital group. The responses of the participants on several aspects of AKI management and renal replacement therapy were analysed and detailed.

Results
97 (66%) nephrologists from 8 Brazilian states responded. 45% referred KDIGO 2 as the stage usually present at time of nephrologist consultation, and mean time for nephrology consultation after AKI diagnosis was 24-48h for 51% of answers. 85% reported creatinine as the only biomarker available for diagnosis, and only 24% reported any AKI alert system. Sepsis was reported as the most frequent etiology by 95%; kidney biopsy indication was considered in less than 10% of the evaluations by 94%. Fluid status assessment is described in Figure 1. The most common criteria for starting RRT was fluid overload (30%) followed by urine output reduction (26%), hyperkalemia (14%) and acidosis (17%). 62% of them usually use furosemide stress test before RRT indication. Seventy-seven percent of participants said that never use peritoneal dialysis in AKI patients, although its available for 44% of responders. Hypotension was the most frequent RRT complication for 91% responders, followed by coagulation of the system for 42% and catheter dysfunction for 33%. CRRT was available for 92% of participants and for 88% this is the RRT for patients using vasoactive drugs. 77% usually use regional anticoagulation with citrate. The most common starting dose is 26 to 30ml/Kg/h and the net ultrafiltration rate is 1,01-1,75 ml/Kg/h. There is no weaning protocol of RRT for 81%, but 90% use the urine output as a weaning tool. Thirty- nine percent said that RRT patients’ mortality stayed between 20 to 50%, and 36% had no information about mortality.

Conclusion
In our survey, Nephrology consultation occurred after 24h and at KDIGO 2 stage. Early recognition of AKI is impeded by the use of serum creatinine as the only biomarker and the unavailability of AKI alerts. Fluid overload is the main reason for indicating RRT and nephrologists have expanded the use of non-invasive fluid status assessment methods others than physical examination. CRRT is the method of choice for unstable patients in this sample from private medical facilities, where almost all responders have access to CRRT. Effluent doses and net ultrafiltration rate were in accordance with the established in literature. Optimal timing for discontinuing RRT is still defined according to the physician's discretion. Standardization of AKI management and continuing education seem to be a fundamental aspect to anticipate the diagnosis, improve the therapeutic approach and bring better results for AKI patients.