Physician-Reported Practices and Innovation Adoption in Acute Kidney Injury Care in Saudi Arabia: A Nationwide Cross-Sectional Survey

Abstract

Background: Acute kidney injury (AKI) is a major public health concern in Saudi Arabia, where diabetes mellitus, hypertension, sepsis, and critical illness contribute substantially to kidney-related morbidity and mortality. Although international standards for AKI diagnosis and treatment are widely available, national data on physician-reported practice patterns and adoption of emerging diagnostic and therapeutic innovations remain limited. Materials and Methods: This nationwide cross-sectional survey was conducted from January to June 2025 among physicians involved in AKI care across public, private, and military healthcare facilities in all 13 administrative regions of Saudi Arabia. Participants were recruited through purposive-stratified sampling. The survey assessed physician characteristics, AKI definition and screening practices, current management strategies, biomarker use, artificial intelligence (AI)-enabled tools, telemedicine, emerging therapies, and perceived barriers and facilitators. Results: A total of 850 of 1,250 invited physicians responded, yielding a response rate of 68%. Most respondents reported using Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI definition (82%), fluid optimization protocols (91%), and nephrotoxin-avoidance checklists (88%). Early nephrology consultation within 24 hours was reported by 64% of hospitals and was more frequent in tertiary than secondary centers (78% vs. 45%; P<0.001). Any biomarker use was reported by 37% of physicians, with higher adoption in tertiary centers than secondary centers (52% vs. 18%; P<0.001). Awareness of selected emerging therapies was moderate, but clinical implementation remained below 12%. The main reported barriers were cost (68%), insufficient training (55%), and lack of local clinical guidelines (47%). Conclusion: Physician-reported AKI management in Saudi Arabia shows substantial alignment with international standards, particularly in preventive and supportive care. However, gaps remain in early nephrology involvement, biomarker implementation, AI-enabled prediction, and equitable access to innovation. National AKI guidelines, targeted training, and structured funding mechanisms may improve early detection, standardize practice, and reduce AKI-related complications.