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Development of a Clinical Research Agenda for Acute Kidney Injury Using an International, Interdisciplinary, Three-Step Modified Delphi Process

John A. Kellum^*, Ravindra L. Mehta, Adeera Levin, Bruce A. Molitoris, David G. Warnock^||, Sudhir V. Shah^¶, Michael Joannidis^**, Claudio Ronco; for the Acute Kidney Injury Network (AKIN)

^* Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Medicine, University of California at San Diego, San Diego, California; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Indiana University, Indianapolis, Indiana; ^|| Department of Medicine, University of Alabama, Birmingham, Alabama; ^¶ Department of Medicine, University of Arkansas, Little Rock, Arkansas; ^** Department of Medicine, Medical University of Innsbruck, Innsbruck, Austria; and Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy

Correspondence: Dr. John A. Kellum, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall, Room 608, 3550 Terrace Street, Pittsburgh, PA 15261. Phone: 412-647-0740; Fax: 412-647-8060; E-mail: kellumja{at}ccm.upmc.edu

Background and objectives: Although acute kidney injury is common and significantly increases the risk for intensive care unit and hospital mortality, little is known about its true incidence or how it can be prevented. Furthermore, key unanswered questions remain about the optimal diagnosis and treatment of patients with acute kidney injury. An international, consensus-based, prioritized research agenda was sought to guide clinical and translational research in acute kidney injury.

Design, setting, participants, & measurements: A three-step modified Delphi process involving 43 participants representing 19 professional societies, organizations, and multiple stakeholder groups ranging from clinical practice to basic science research was conducted.

Results: Twenty research questions were generated across six focus groups. Overall, research priorities generated from nephrologists and intensivists were similar and highly correlated. The stakeholder groups included members from 15 countries. Results from adult and pediatric groups showed important differences, as did results from developing compared with developed countries; however the priority rankings from the developed and developing countries were significantly correlated. Top research priorities in acute kidney injury include determining optimal timing of renal replacement therapy and improving the understanding of the epidemiology of acute kidney injury around the world.

Conclusions: Research recommendations that are highly consistent across various stakeholder groups and between developed and developing countries have been produced. It is hoped that these recommendations will prove valuable in guiding future clinical and translational research in this area.

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