Dataset Information

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

ABSTRACT:

Background

Renin-angiotensin system inhibitors (RASi) are not re-initiated for almost a quarter of patients who suffered acute kidney injury 6 months after discharge. This discontinuation might be partly explained by the nephrotoxicity of these medications, yet they remain of benefit, especially for patients with heart failure.

Objective

To determine the factors deemed by clinicians to influence RASi re-initiation and set threshold values for important safety parameters.

Design

Three-round modified online Delphi survey.

Setting

The study was conducted in Quebec, Canada.

Participants

Twenty clinicians from nephrology, intensive care medicine, and internal medicine.

Measurements

The factors' importance was rated on 4-point Likert-type scale, ranging from "not important" to "very important" by the panelists.

Methods

We conducted a brief literature review to uncover possible influencing factors followed by a 3-round modified Delphi survey to establish a consensus on the importance of these factors.

Results

We recruited 20 clinicians (7 nephrologists, 3 internists, and 10 intensive care physicians). We created a list of 25 factors, 15 of which met consensus. Eleven of these factors, including serum creatinine, glomerular filtration rate, and acute kidney injury (AKI) stage, were deemed as important while 4, such as responsibility ambiguity and absence of feedback, were deemed as not important. The majority of the 10 factors which did not meet consensus were related to the clinical setting, such as a pharmacist follow-up and the required time to ensure optimal RASi re-initiation.

Limitations

Quebec clinicians' agreement might not reflect the opinion of the rest of Canada. The survey measures clinicians' belief rather than their actual practice.

Conclusion

Renin-angiotensin system inhibitors re-initiation is a rather complex concept which encompasses several factors. Our research uncovered some of these factors which may be used to develop guidelines on optimal RASi re-initiation.

SUBMITTER: Dahel H

PROVIDER: S-EPMC9290153 | biostudies-literature |

REPOSITORIES: biostudies-literature

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