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Technology and health care for the elderly medical research studies

Focus on strategic priorities that have significant social impact.

CORE 2012-15

OPTIMAL Selection for and Timing to Start Renal Replacement in Critically Ill Older Patients with Acute Kidney Injury (OPTIMAL-AKI)

This study seeks to address the severe lack of information on the optimal circumstances for starting dialysis in older patients with acute kidney injury (AKI) and older critically ill Canadians.

Research Results

Impact of findingsWe anticipate our findings will greatly inform current practice and facilitate the development of tools to optimally select older patients who are most likely to benefit from acute dialysis in the setting of critical illness. This multi-centre OPTIMAL-AKI study, nested within the STARRT-AKI program is highly relevant and closely aligned with the mission of the Canadian Frailty Network. OPTIMAL-AKI is specifically aimed to improve the care and establish best practice in older critically ill frail patients through a rigorous evaluation of the factors, processes and outcomes associated with the utilization of dialysis.

About the Project

Severe AKI has a high risk of death and permanent loss of kidney function and usually occurs in an intensive care setting. Dialysis is commonly prescribed and there is substantial debate about when to start, particularly in the elderly who make up half of all patients receiving this treatment.

The results will ensure these decisions are consistently guided by high-quality evidence across Canada. The study will also address the large variations in practice between providers, hospitals and across jurisdictions that undermines the optimal selection and delivery of high-quality care to older critically ill patients with AKI. Practice will be improved and tools will be developed to select older patients who are most likely to benefit from acute dialysis in the setting of critical illness.

For more details on the project rationale, objectives and research plan, click here. 

Project Team

Principal Investigators:

Sean Bagshaw, MD, MSc, FRCPC -- University of Alberta

Ron Wald, MDCM, MPH, FRCPC -- St. Michael's Hospital/University of Toronto


Neill Adhikari, MDCM, MSc, FRCPC -- Sunnybrook Health Sciences Centre/University of Toronto

Karen Burns, MD, MSc, FRCPC -- St. Michael's Hospital/University of Toronto

Jan Friedrich, MD, MSc, DPhil, FRCPC -- St. Michael's Hospital/University of Toronto

Project Contact: Dr. Sean Bagshaw --

CORE 2012-15

Key words: frail elderly; renal replacement therapy; acute kidney injury; critical illness