A detailed description of the methods is in the electronic supplemental material (ESM). 1, Table 1, ESM Table 3 and ESM Table 4). Additionally, recommendations for practice were graded using the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria (Fig. Recommendations for research were formulated for all key areas. After the conference, the writing committee compiled the rationale for each statement based on the identified literature.
Consensus statements were iteratively developed and refined in response to feedback during plenary sessions involving all ADQI delegates, and final consensus statements were agreed.
Consensus statements were then proposed and supported by evidence and/or consensus where evidence was limited. ADQI methodology begins with a pre-conference comprehensive literature search and appraisal of scientific evidence to identify key themes allotted to workgroups (ESM Table 1, ESM Table 2).
The methodology of ADQI ( ) consensus meetings is well established having undergone subsequent refinements in the past two decades. anti-GBM disease) in which specific inflammatory mechanisms target both organs were not considered. Epidemiology, pathophysiology, and potential mitigating interventions/strategies relevant to lung–kidney interactions were examined, including the association between ARDS, IMV, and/or extracorporeal membrane oxygenation (ECMO) with AKI, and/or renal replacement therapy (RRT). Therefore, a consensus conference was organized under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018, involving experts in nephrology, critical care and pulmonology. Surprisingly, lung–kidney interactions have not been extensively studied. Patients with acute respiratory failure/acute respiratory distress syndrome (ARF/ARDS, ESM Table 6) are at increased risk of AKI, especially where IMV is required, influenced by haemodynamic, neurohormonal, and inflammatory effects. Patients with acute kidney injury (AKI, ESM Table 5) are twice as likely to require invasive mechanical ventilation (IMV). In critically ill patients, both lung and kidney organ injury and/or dysfunction are common and associated with significant morbidity and mortality. Recommendations for research were formulated, targeting lung–kidney interactions to improve care processes and outcomes in critical illness. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. MethodsĪ consensus conference on the spectrum of lung–kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO).