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The 17th Acute Disease Quality Initiative International Consensus Conference: Introducing Precision Renal Replacement Therapy

[11, 12] have provided much evidence but no definitive conclusions. Thus, practice variation continues and may in fact be warranted. These heterogeneous results underscore a fundamental limitation for randomized trials. A single best solution may not exist for all or even most patients. Lack of a ‘onesize fits all’ answer to complex medical problems is not uncommon. There is no ‘best’ dose of insulin to treat diabetes and no ‘best’ antibiotic. Treatments must be tailored to the specific patient or specific disease condition. The search for one dose, modality and time for initiation of RRT that is ‘best’ for all patients will never be fruitful. Given these considerations, the 17th Acute Disease Quality Initiative (ADQI) International Consensus Conference sought to revisit CRRT 16 years later and to focus on the development of core concepts to advance ‘precision renal replacement therapy’. Precision medicine is an innovative approach that takes into account individual differences in people’s genes, environments and lifestyles. It allows targeting specific treatments of illnesses by selecting different drugs and doses that do not just work for the average patient but are chosen specifically for an individual. Precision RRT therefore is the use of specific In August 2000, we convened the first international consensus conference under the banner of the Acute Dialysis Quality Initiative [1] . The focus of the conference was on continuous renal replacement therapy (CRRT) and 46 questions were evaluated covering the broad domains of definitions/nomenclature, patient selection, solute control, membranes, operational characteristics, access and anticoagulation and fluid composition and management. Of the 46 questions, consensus was identified for 20, the existence of evidence but no consensus for 5 (concerning membranes, catheters, modality and dose) and insufficient evidence for the remaining 21. A detailed research agenda was proposed to address these knowledge gaps. Over the years, since the publication of these findings, much has changed. We recommended the development of standard criteria for diagnosing acute kidney injury (AKI) and then these criteria were defined [2], and subsequently refined [3, 4] and validated in multiple studies [5] . Since 2002, large randomized trials [6, 7] have provided evidence by which to base clinical recommendations and the first clinical practice guideline was published on AKI in 2012 [4] . However, much controversy remains and the practice of CRRT continues to be variable across centers. New trials exploring the timing of initiation [8–10] of RRT and large observational studies exploring the effects of modality on renal recovery after AKI Published online: August 26, 2016