The Acute Dialysis Quality Initiative: the New York conference

Over 300,000 Americans develop acute renal failure each year, and half die. In recent years, there have been considerable advances in our understanding and technical capabilities, but consensus over the optimal way to deliver care does not exist. Consequently, a conference held in New York in the year 2000 has given birth to the Acute Dialysis Quality Initiative (ADQI). The conference aimed at establishing an evidence-based appraisal and set of consensus recommendations to standardize care and direct further research on the application of continuous renal replacement therapy (CRRT). CRRT is being used at ever-increasing rates in the United States. Today, approximately one quarter of all patients with acute renal failure are treated with CRRT. Despite the increasing use, there are presently no published standards for the application of this therapy, and practice patterns vary widely between individual centers. Results from recent clinical trials on selection of dialysis membranes and dialysis dose provide strong, yet often conflicting, evidence to guide therapy. Other areas of uncertainty have not been sufficiently addressed by clinical studies and directives for future research are needed. Finally, the success of multicentered clinical trials in supportive care in the intensive care unit (transfusion thresholds and ventilator management) have intensified and renewed interest in the study of supportive care methods as a major target for future research. These developments have set the stage for the first ADQI conference; the final objectives are the development of evidence-based practice guidelines and directions for future research.