Appendix
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APPENDIX 1: SAMPLE SURVEY Parameters used to Discontinue Dialysis in Acute Kidney Injury Recovery: A Survey of Unites States Nephrologist. 1.How many years have you been in Nephrology? a..Less than 2 years. b. Between 2 to 5 years. c. More than 10 years 2. How would you describe your practice? a. University hospital b. Private hospital with university affiliation c. Private hospital d. Other 3. How many patients with acute kidney injury do you see in a year? a. less than 5 a year b. between 5-10 a year c. between 10-20 a year d. more than 20 a year 4. Of those with acute kidney injury what percentage need dialysis? a. less than 10% b. between 10%-30% c. more than 30 5. Does your hospital automatically calculate eGFR with serum chemistry? a.yes b.no 6. When weaning patients with AKI off dialysis select all that apply from the following parameters. least important important more important most important *When weaning patients with AKI off dialysis select all that Hyperkalemia apply from the Hyperkalemia Hyperkalemia Hyperkalemia resolves: K+ is now following resolves: K+ is now resolves: K+ is now resolves: K+ is now less than parameters. less than 6.5meq/L. less than 6.5meq/L. less than 6.5meq/L. 6.5meq/L. Hyperkalemia important more important most important resolves: K+ is now less than 6.5meq/L. least important Metabolic Metabolic Acidosis Acidosis resolves. resolves. least important Metabolic Acidosis resolves. important Metabolic Acidosis resolves. more important Metabolic Acidosis resolves. most important The patient is The patient is not not oliguric any oliguric any more. more. least important The patient is not oliguric any more. important The patient is not oliguric any more. more important The patient is not oliguric any more. most important The patient is not volume overloaded any more. important The patient is not volume overloaded any more. more important The patient is not volume overloaded any more. most important Pre-dialysis serum creatinine is lower despite the same dose of dialysis. more Pre-dialysis serum creatinine is lower despite the same dose of dialysis. most The patient is The patient is not not volume volume overloaded overloaded any any more. more. least important Pre-dialysis serum Pre-dialysis Pre-dialysis creatinine is lower serum creatinine is serum creatinine is despite the same lower despite the lower despite the dose of dialysis. same dose of same dose of dialysis. least least important important more important most important important dialysis. important important important Pre-dialysis serum blood urea nitrogen is lower despite the same dose of dialysis. Pre-dialysis Pre-dialysis serum blood urea serum blood urea nitrogen is lower nitrogen is lower despite the same despite the same dose of dialysis. least dose of dialysis. important important Pre-dialysis serum blood urea nitrogen is lower despite the same dose of dialysis. more important Pre-dialysis serum blood urea nitrogen is lower despite the same dose of dialysis. most important Clinical improvement occurs: Blood pressure stabilizes without pressors. Clinical improvement occurs: Blood pressure stabilizes without pressors. least important Clinical improvement occurs: Blood pressure stabilizes without pressors. more important Clinical improvement occurs: Blood pressure stabilizes without pressors. most important Respiratory parameters improve. Respiratory Respiratory Respiratory Respiratory parameters improve. parameters improve. parameters improve. parameters improve. least important important more important most important Cognition improves. Cognition improves. least important Clinical improvement occurs: Blood pressure stabilizes without pressors. important Cognition Cognition improves. more improves. important important Cognition improves. most important 7. Would you continue to dialyze a patient with a persistently elevated potasssium even if the serum creatinine is now 1.5-2 mg/dL? a. Yes b. No 8. Before stopping dialysis in a patient with AKI, do you get a creatinine clearance with a timed urine collection? a. Yes proceed to the next question . b. No skip the next question. 9. If you do a timed creatinine clearance to determine if you should stop dialysis in a patient with AKI due to renal function recovery select all that apply. can safely stop dialysis can stop and see if less comfortable further dialysis with stopping needed dialysis cannot stop dialysis *If you do a timed creatinine clearance to determine if you less than less than should stop dialysis less than 12ml/min in a patient with AKI 12ml/min can stop 12ml/min less and see if further comfortable with due to renal function dialysis needed stopping dialysis recovery select all that apply. less than 12ml/min can safely stop dialysis less than 12ml/min cannot stop dialysis between 1220ml/min between 12between 12between 1220ml/min can stop 20ml/min less 20ml/min can safely and see if further comfortable with stop dialysis dialysis needed stopping dialysis between 1220ml/min cannot stop dialysis more than 20ml/min more than more than more than 20ml/min can stop 20ml/min less 20ml/min can safely and see if further comfortable with stop dialysis dialysis needed stopping dialysis more than 20ml/min cannot stop dialysis 10. You would stop dialysis in the following scenarios True False Hyperkalemia Hyperkalemia resolves and patient is *You would stop dialysis in the resolves and volume overloaded. False patient is volume following scenarios Hyperkalemia resolves True overloaded. False and patient is volume overloaded. True Hyperkalemia resolves and the Hyperkalemia resolves and the creatinine creatinine clearance is about 10ml/min clearance is about True 10ml/min Hyperkalemia resolves and the creatinine clearance is about 10ml/min False Hyperkalemia Hyperkalemia resolves and acidosis is Hyperkalemia resolves and acidosis is resolves and present False acidosis is present present True Hyperkalemia resolves and the patient is septic and catabolic Hyperkalemia resolves and the patient is septic and catabolic True Hyperkalemia resolves and the patient is septic and catabolic False 11. Oliguria resolves and you are considering stopping dialysis in the setting of AKI. Which of the following would make you continue dialysis. No Hyperkalemia is present Unlikely Yes *Oliguria resolves and you are considering stopping dialysis in the setting of AKI. Which of the Hyperkalemia is Hyperkalemia is Hyperkalemia is following would present Unlikely present Likely present Yes make you continue dialysis. Hyperkalemia is present No Metabolic Metabolic acidosis acidosis is present is present No Creatinine Clearace Likely Creatinine Metabolic acidosis is present Unlikely Metabolic acidosis is present Likely Metabolic acidosis is present Yes Creatinine Creatinine Creatinine No is 10ml/min Unlikely Yes Clearace is 10ml/min Clearace is 10ml/min Clearace is 10ml/min Clearace is 10ml/min No Unlikely Likely Yes Sepsis is present Sepsis is present No Cognition has not Cognition has improved not improved No Sepsis is present Sepsis is present Sepsis is present Unlikely Likely Yes Cognition has not improved Unlikely Respiratory Respiratory failure Respiratory failure is present is present failure is present No Unlikely Congestive Heart Failure is present Likely Congestive Heart Failure is present No Congestive Heart Failure is present Unlikely Cognition has Cognition has not improved Likely not improved Yes Respiratory failure is present Likely Respiratory failure is present Yes Congestive Heart Failure is present Likely Congestive Heart Failure is present Yes 12. Getting patients off dialysis for AKI takes longer in the following scenarios, pick all that apply No Unlikely *Getting patients off dialysis for AKI takes longer Age over 65 Age over 65 years in the following years Unlikely scenarios, pick all that apply Age over 65 years No Pre-existing CKD Pre-existing CKD No Pre-existing Pre-existing Likely Yes Age over 65 years Likely Age over 65 years Yes Pre-existing CKD Pre-existing CKD Pre-existing CKD Unlikely Likely Yes Pre-existing Pre-existing Pre-existing No Unlikely Likely Yes Congestive Heart Failure Congestive Heart Failure No Congestive Heart Failure Unlikely Congestive Heart Failure Likely Congestive Heart Failure Yes Multi-organ failure Multi-organ failure No Multi-organ failure Unlikely Multi-organ failure Likely Multi-organ failure Yes 13. After taking a patient off dialysis for AKI with improvement, you had to restart dialysis in a 28 day period for - pick all that apply. No Unlikely Likely Yes Recurrence of sepsis Likely Recurrence of sepsis Yes Recurrence of sepsis *After taking a patient off dialysis for AKI with improvement, you had to restart Recurrence of dialysis in a 28 day sepsis Unlikely period for - pick all that apply. Recurrence of sepsis No Recurrent nephrotoxin exposure like intravenous contrast Recurrent Recurrent Recurrent Recurrent nephrotoxin nephrotoxin nephrotoxin nephrotoxin exposure like exposure like exposure like exposure like intravenous contrast intravenous contrast intravenous contrast intravenous contrast No Unlikely Likely Yes Recurrent nephrotoxin exposure like antibiotics Recurrent nephrotoxin exposure like antibiotics No Recurrence of Recurrence of renal disease like renal disease like Recurrent Recurrent nephrotoxin nephrotoxin exposure like exposure like antibiotics Unlikely antibiotics Likely Recurrent nephrotoxin exposure like antibiotics Yes Recurrence of renal disease like Recurrence of renal disease like Recurrence of renal disease like No Unlikely Likely Yes vasculitis or renal vasculitis or renal obstruction obstruction No vasculitis or renal vasculitis or renal obstruction Unlikely obstruction Likely vasculitis or renal obstruction Yes Recurrence of Congestive Heart Failure Recurrence of Congestive Heart Failure Unlikely Recurrence of Congestive Heart Failure Likely Recurrence of Congestive Heart Failure Yes Dialysis was stopped too early Likely Dialysis was stopped too early Yes Recurrence of Congestive Heart Failure No Dialysis was Dialysis was Dialysis was stopped too early stopped too early No stopped too early Unlikely 14. After being taken off dialysis, it may need to be re-started in a 28 day period due ot - pick all that apply: No Unlikely Likely Yes *After being taken off dialysis, it may need to be reRecurrence of the started in a 28 day Recurrence of Recurrence of initial problem period due ot - pick the initial problem the initial problem causing AKI. all that apply: causing AKI. Unlikely causing AKI. Likely Recurrence of the initial problem causing AKI. No Recurrence of the initial problem causing AKI. Yes Dialysis was Dialysis was Dialysis was stopped too eary. stopped too eary. Nostopped too eary. Unlikely Dialysis was stopped too eary. Yes Dialysis was stopped too eary. Likely eGFR continued eGFR continued eGFR continued to eGFR continued eGFR continued to decline for to decline for decline for unclear to decline for to decline for unclear reasons. unclear reasons. reasons. unclear reasons. No unclear reasons. Yes Unlikely Likely 15. Of those who get dialysis for AKI in the hospital select all that apply No >50% die unlikely *Of those who get dialysis for AKI in >50% die the hospital select all unlikely that apply >50% die No 20 to 50% die 20 to 50% die No 5-20 % die 5-20 % die No <5% die <5% die No 20 to 50% die unlikely 5-20 % die unlikely <5% die unlikely likley Yes >50% die likley 20 to 50% die likley >50% die Yes 20 to 50% die Yes 5-20 % die likley 5-20 % die Yes <5% die likley <5% die Yes 16. Of those that start dialysis for AKI most will - select all that apply No unlikely likely Yes *Of those that start dialysis for AKI Need to Need to Need to Need to continue most will - select all continue dialysis and continue dialysis and continue dialysis and dialysis and will that apply Need to will not be able to will not be able to will not be able to not be able to come off dialysis. come off dialysis. come off dialysis. continue dialysis and come off dialysis. will not be able to unlikely likely Yes come off dialysis. No Many will come Many will come Many will come Many will come Many will come off but will have CKD off but will have CKD off but will have CKD off but will have CKD off but will have CKD No unlikely likely Yes Many will have to Many will have Many will have Many will have Many will have be followed up even if present serum creatinine normalizes. No unlikely likely Yes to be followed up even if present serum creatinine normalizes. No to be followed up even if present serum creatinine normalizes. unlikely to be followed up even if present serum creatinine normalizes. likely to be followed up even if present serum creatinine normalizes. Yes
