Global heterogeneity and implementation gap in acute kidney injury prevention: Results from the AKI-PURIFY survey
15 affiliations
- 1Centre for Medical Sciences (CISMed), University of Trento, Trento, Italy
- 2Department of Biotechnologies, Intensive Care and Perioperative Medicine, Catholic University of the Sacred Heart, Rome, Italy
- 3Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
- 4William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- 5Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
- 6Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
- 7Departments of Intensive Care and Nephrology, Royal Melbourne Hospital, Melbourne, Australia
- 8Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- 9Department of Intensive Care Medicine, Centre Hospitalier Universitaire Namur Godinne, Catholic University of Louvain, site Godinne, Belgium
- 101st Intensive Care Unit, General Hospital of Thessaloniki “G.Papanikolaou”, Thessaloniki, Greece
- 11Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- 12Intensive Care Department, Vall d’Hebron University Hospital, SODIR-VHIR Research Group, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- 13Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, School of Medicine, Catholic University of Zagreb, Zagre, Croatia
- 14Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- 15Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland
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.
Methods: 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.
Results: 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.
Conclusions: 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.
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BibTeX
@article{rosa2026global,
title = {{Global heterogeneity and implementation gap in acute kidney injury prevention: Results from the AKI-PURIFY survey}},
author = {Silvia De Rosa and Salvatore Lucio Cutuli and Sergio Lassola and John Prowle and Thilo von Groote and Alexander Zarbock and Melanie Meersch-Dini and Kent Doi and Emily See and Kevin Roedl and Patrick M. Honoré and Christina Chrysanthi Theocharidou and Max Bell and Ricard Ferrer and Vedran Premužić and Ahmed Mohamed Sabri Zaher and Bairbre McNicholas},
journal = {Journal of intensive medicine},
year = {2026},
month = jun,
doi = {10.1016/j.jointm.2026.04.005},
url = {https://europepmc.org/article/PMC/PMC13728402},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Global heterogeneity and implementation gap in acute kidney injury prevention: Results from the AKI-PURIFY survey
AU - Silvia De Rosa
AU - Salvatore Lucio Cutuli
AU - Sergio Lassola
AU - John Prowle
AU - Thilo von Groote
AU - Alexander Zarbock
AU - Melanie Meersch-Dini
AU - Kent Doi
AU - Emily See
AU - Kevin Roedl
AU - Patrick M. Honoré
AU - Christina Chrysanthi Theocharidou
AU - Max Bell
AU - Ricard Ferrer
AU - Vedran Premužić
AU - Ahmed Mohamed Sabri Zaher
AU - Bairbre McNicholas
PY - 2026
DA - 2026/06/13
JO - Journal of intensive medicine
DO - 10.1016/j.jointm.2026.04.005
UR - https://europepmc.org/article/PMC/PMC13728402
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2097-0250
SN - 2667-100X
ER -