{ "abstract": "Background: Despite substantial advances in critical care nephrology, the real-world implementation of diagnostic tools and evidence-based preventive strategies for acute kidney injury (AKI) in critically ill patients remains poorly defined. Understanding the gap between guideline recommendations and bedside practice is essential to inform targeted quality-improvement initiatives. The AKI-PURIFY survey was designed to provide a contemporary international overview of AKI diagnosis and management in the ICU, with emphasis on implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) preventive strategies and determinants with its adoption. We hypothesized that implementation of evidence-based preventive care varies across healthcare settings and is influenced by clinician training and organizational capacity.\n\nMethods: AKI-PURIFY was a multicenter, international online survey endorsed by the European Society of Intensive Care Medicine (ESICM), conducted between February and April 2024. Healthcare professionals involved in intensive care unit (ICU) management of AKI were invited to participate. The survey explored diagnostic strategies, implementation of the KDIGO kidney prevention strategy, renal replacement therapy practices, and perceived organizational and educational barriers. Multivariable logistic regression analyses were conducted to identify factors independently associated with the use of diagnostic tools and the implementation of preventive strategies.\n\nResults: A total of 703 respondents completed the survey. Routine implementation of the KDIGO kidney prevention strategy was reported by 36.3% of participants (47.0% among valid responses). Diagnostic practices varied across ICU and resource settings, and the use of AKI damage biomarkers remained low. In adjusted analyses, inadequate training (odds ratio [OR]=0.56, 95% confidence interval [CI]: 0.37 to 0.84, P=0.007) and higher organizational barrier scores (OR=0.78, 95% CI: 0.63 to 0.97, P=0.030) were independently associated with lower implementation. Clear income-level gradients were observed across diagnostic strategies, training adequacy, and organizational capacity.\n\nConclusions: Adoption of guideline-recommended AKI prevention strategies remains inconsistent worldwide and is influenced by modifiable educational and system-level factors. Addressing this gap will require coordinated, context-sensitive strategies integrating structured training and scalable quality-improvement frameworks.", "abstract_shown": true, "affiliations": [ "Centre for Medical Sciences (CISMed), University of Trento, Trento, Italy", "Department of Biotechnologies, Intensive Care and Perioperative Medicine, Catholic University of the Sacred Heart, Rome, Italy", "Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy", "William Harvey Research Institute, Queen Mary University of London, London, United Kingdom", "Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany", "Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan", "Departments of Intensive Care and Nephrology, Royal Melbourne Hospital, Melbourne, Australia", "Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany", "Department of Intensive Care Medicine, Centre Hospitalier Universitaire Namur Godinne, Catholic University of Louvain, site Godinne, Belgium", "1st Intensive Care Unit, General Hospital of Thessaloniki “G.Papanikolaou”, Thessaloniki, Greece", "Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden", "Intensive Care Department, Vall d’Hebron University Hospital, SODIR-VHIR Research Group, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain", "Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, School of Medicine, Catholic University of Zagreb, Zagre, Croatia", "Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom", "Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland" ], "article_type": "research article", "arxiv": null, "author_total": 17, "authors": [ { "affs": [ 0 ], "name": "Silvia De Rosa" }, { "affs": [ 1 ], "name": "Salvatore Lucio Cutuli" }, { "affs": [ 2 ], "name": "Sergio Lassola" }, { "affs": [ 3 ], "name": "John Prowle" }, { "affs": [ 4 ], "name": "Thilo von Groote" }, { "affs": [ 4 ], "name": "Alexander Zarbock" }, { "affs": [ 4 ], "name": "Melanie Meersch-Dini" }, { "affs": [ 5 ], "name": "Kent Doi" }, { "affs": [ 6 ], "name": "Emily See" }, { "affs": [ 7 ], "name": "Kevin Roedl" }, { "affs": [ 8 ], "name": "Patrick M. Honoré" }, { "affs": [ 9 ], "name": "Christina Chrysanthi Theocharidou" }, { "affs": [ 10 ], "name": "Max Bell" }, { "affs": [ 11 ], "name": "Ricard Ferrer" }, { "affs": [ 12 ], "name": "Vedran Premužić" }, { "affs": [ 13 ], "name": "Ahmed Mohamed Sabri Zaher" }, { "affs": [ 14 ], "name": "Bairbre McNicholas" } ], "bibtex": "https://research.draconitic.com/paper/1yty8m7bm0hc7.bib", "cited_by": 0, "doi": "10.1016/j.jointm.2026.04.005", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13728402/?tool=EBI", "id": "1yty8m7bm0hc7", "issns": [ "2097-0250", "2667-100X" ], "landing_url": "https://europepmc.org/article/PMC/PMC13728402", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Original Article" ], [ "openalex", "2727|Acute Kidney Injury Research" ] ], "openalex": "W7164665762", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13728402/pdf/?tool=EBI", "pmcid": "PMC13728402", "pmid": "42978886", "published": "2026-06-13", "publisher": "Elsevier", "ris": "https://research.draconitic.com/paper/1yty8m7bm0hc7.ris", "sources": [ { "first_seen": "2026-11-04T15:20:47Z", "native_id": "PMC:PMC13728402", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13728402" }, { "first_seen": "2026-11-07T12:21:24Z", "native_id": "PMC13728402", "source": "pmc", "url": "https://doi.org/10.1016/j.jointm.2026.04.005" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2727|Acute Kidney Injury Research", "subfield": "general" } ], "title": "Global heterogeneity and implementation gap in acute kidney injury prevention: Results from the AKI-PURIFY survey", "title_text": "Global heterogeneity and implementation gap in acute kidney injury prevention: Results from the AKI-PURIFY survey", "type": "peer-reviewed", "updated_at": "2026-11-07T12:21:24Z", "url": "https://research.draconitic.com/paper/1yty8m7bm0hc7", "venue": "Journal of intensive medicine", "versions": [] }