Copy of Acute Dialysis Survey

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* 1. Please describe your specialty (Check all that apply):

Nephrologist

Intensivist

Pediatric Specialist

Physician other than nephrologist or intensivist

Other (please specify)

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* 2. Which Country are you located

United States

Canada

Other (please specify)

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* 3. Your Hospital Type / Funding

Public

Private

University-Affiliated

Charitable

Not in Hospital-based Practice

Other…

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* 4. Who is primarily responsible for decisions for starting, prescribing and delivering acute dialysis for critical ill patients at your institution?

Primary ICU team

Nephrology Team

Multidisciplinary decision

Other (please specify)

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* 5. What best describes your current approach to determining initiation of RRT for AKI?

I offer dialysis only when there is evidence that the kidneys have failed and are not likely to recover

I start only when conservative measures have failed to correct the indications for dialysis

I start dialysis if the patient is anticipated to require renal support even in the absence of specific indications

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* 6. Which of the following statements regarding randomized clinical trials of timing of acute dialysis in critically ill patients published in the NEJM and JAMA do you agree with?

Based on current indications to determine the time for initiating dialysis, over 40% of patients may not need dialysis.

Patients initiated on dialysis in the absence of major complications have a higher rate of long-term need for dialysis.

Withholding dialysis until there is prolonged oliguria and severe complications is associated with higher mortality.

The current criteria for initiating acute dialysis are inadequate in determining when dialysis should be initiated or stopped.

There is no survival benefit of early vs late start of dialysis based on the criteria used in the clinical trials.

Other (please specify)

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* 7. Based on your experience of acute dialysis in your hospitals, please select the percentage of patients who meet each of the following conditions. The total should be 100%.

Dialysis is started in patients who did not need it.

Dialysis is started in patients are unlikely to benefit and it is futile.

Dialysis is started for emergent life-threatening indications.

Dialysis is planned and started when patient is most likely to benefit.

Dialysis is offered as a trial of therapy.

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* 8. Spending for hospitalizations with acute dialysis has showed an increase of over $40,000 in hospitalization costs, an increase in length of stay by almost two weeks and rehospitalization rates >30% within 3 months, has prompted the CMS to track the expenses associated with each dialysis linked to providers and establish this as a cost measure for value based payments to physicians (2021 CMS Cost Measure #20) https://qpp.cms.gov/docs/cost_specifications/2019-12-17-mif-ebcm-aki-new-hd.pdf).
In your opinion, which of the following would be most important in reducing the cost of acute dialysis and improving outcomes in these patients.

Identify and track high risk patients who will require dialysis to optimize timely decisions for therapy application

Standardize the timing, delivery and monitoring of acute dialysis to reduce variation in therapy application

Improve communications among care team and with patients and surrogates for shared decision making

Improve service efficiency and resource management to prevent crisis management for dialysis delivery

Personalize dialysis delivery based on predictive analytics accounting for patient characteristics and process of care elements

Other (please specify)

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* 9. Consider the following facts:
Requirement of acute dialysis in the hospital is associated with 30-50% hospital mortality, survivors more likely to die within 12 months.
At hospital discharge < 30% go home; 40% re-hospitalized within 1 year.
Please rank order the following factors in order of importance to be prioritized for managing acute dialysis to improve these outcomes.

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* 10. Given the complexity of care of patients with multi-organ failure requiring organ support, which of the following features would you be most likely to
utilize in a clinical decision support system for acute dialysis based on
predictive models validated over > 100,000 patients across 5 international centers with excellent discrimination (AUC >0.95), calibration, and positive and negative predictive values.

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* 11. In your opinion which other areas of predictive models for clinical decision support would be needed to improve patient outcomes?

AKI Prediction

Sepsis

Need for Ventilators

Transition / Stopping Therapy

Readmission (within 30 days)

Other (please specify)