Reducing mortality in acute kidney injury: The democracy-based approach to consensus

Evidence-based medicine is the gold standard approach in modern medical epistemology. However, there is increasing concern about the low number of evidence-based clinical practices and high-quality multicenter randomized trials in the critical care field. Consensus conferences and guidelines on which physicians base their clinical practice often rely on expert opinions more than on high-quality evidence. Democracy-based medicine is a new method that may allow to overcome some limits of “classic” consensus conferences. Here we describe this democratic, web-based consensus process applied to the first International Consensus Conference aimed to identify all drugs, techniques, and strategies with an impact on mortality in critically ill patients with or at risk for acute kidney injury (AKI). Fifteen interventions which have been suggested to increase survival and three that might increase mortality were identified through the consensus process by a total of 311 participants from 62 countries. The identified topics are extensively discussed in this book, where a chapter is dedicated to each of these drugs, techniques, or strategies which might affect mortality in patients with or at risk for AKI