Determining Factors Influencing RAS Inhibitors Re-Initiation in ICU: A Modified Delphi Method

Area of Science:

• Nephrology
• Cardiology
• Critical Care Medicine

Background:

• Renin-angiotensin system inhibitors (RASi) are vital for heart failure patients but often discontinued after acute kidney injury (AKI).
• Understanding factors influencing RASi re-initiation is crucial for patient care and optimizing treatment benefits.

Purpose of the Study:

• To identify factors influencing RASi re-initiation among clinicians.
• To establish consensus on threshold values for key safety parameters relevant to RASi re-initiation.

Main Methods:

• A modified online Delphi survey was conducted over three rounds.
• Twenty clinicians from nephrology, intensive care, and internal medicine participated.
• Factors were rated using a 4-point Likert scale to establish consensus.

Main Results:

• Fifteen of 25 factors reached consensus, with 11 deemed important for RASi re-initiation.
• Key important factors included serum creatinine, glomerular filtration rate, and AKI stage.
• Factors like responsibility ambiguity and lack of feedback were considered unimportant.

Conclusions:

• RASi re-initiation is complex, influenced by multiple clinical and safety factors.
• The identified factors can inform the development of clinical guidelines for optimal RASi re-initiation post-AKI.
• Consensus on safety parameters aids in standardizing RASi management.