Acute kidney injury (AKI) is a common accompaniment in critically ill intensive care unit (ICU) patients, with almost 20% of them needing renal replacement therapy (RRT) at some point of hospitalization. RRT practices beyond the mode of therapy, including the timing of initiation, the hardware used, the type of anticoagulation are known to have varying impacts on the patient outcomes including the recovery of kidney function, the morbidity and mortality. RRT is being widely practiced in India, however, the practices are neither uniform nor standardized. Not much data is available from Indian ICUs on the RRT practices and the outcomes thereof.

A pan-nation survey from Indian ICUs in 2020 assessed the RRT practices and RRT resources available in ICUs of various institutions across the country. The survey across 320 institutions attempted to study the factors influencing the indication, initial RRT modality preference, differences in practices with respect to setup of the treating hospitals and data related to indications of CRRT, time of initiation, and anticoagulation used were collected. Being an online survey, the study had its limitations with the data collected being relatively qualitative in nature, the survey was performed exclusively among critical care physicians while the RRT practices among nephrologists may be different and were not reflected in the survey.

The ISCCM guidelines on AKI and RRT had been available online for over an year, but their acceptance into clinical practice is also not known as of now.

With a substantially high utilization of RRT for AKI management in the ICU population, with paucity of quality data from the Indian ICUs, we plan to conduct a prospective observational study to study the prevalent RRT practices and their impact on patient outcomes across the Indian ICUs including the modality of RRT used, at what stage of AKI RRT was planned, the timing and stage of AKI when RRT initiated, the hardware and anticoagulation used, and the outcomes in terms of renal recovery and mortality modality used, the hardware, the time and stage of AKI when RRT initiated. Eventually, the data can help us evolve policies to standardize RRT practices across the country and improve the RRT utilization in management of AKI patients subsequently.

Objectives:

·       To capture the prevalent RRT practices in Indian ICUs

·       To determine the factors associated with the various RRT practices that can affect the outcomes in patients  with AKI, including mortality and the renal recovery.

·       To objectively look into whether Indian guidelines on RRT have been brought into practice