Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

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Abstract

Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever, international, multidisciplinary, clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. In this review we summarize key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management. Contrast-induced AKI and management of renal replacement therapy will be addressed in a separate review. Treatment recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided.

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A positive fluid balance is associated with a worse outcome in patients with acute renal failure

Didier Payen, Anne-Cornélie JM de Pont, Yasser Sakr … (2008)

Introduction Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40% to 65%. The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients. Methods The data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. All adult patients admitted to a participating ICU between 1 and 15 May 2002, except those admitted for uncomplicated postoperative surveillance, were eligible for the study. For the purposes of this substudy, patients were divided into two groups according to whether they had ARF. The groups were compared with respect to patient characteristics, fluid balance, and outcome. Results Of the 3,147 patients included in the SOAP study, 1,120 (36%) had ARF at some point during their ICU stay. Sixty-day mortality rates were 36% in patients with ARF and 16% in patients without ARF (P < 0.01). Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41% versus 33% and 52% versus 32%, respectively; P < 0.01). Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score II (SAPS II), heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation. Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay. Conclusion In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

Stephen A McClave, Robert Martindale, Vincent Vanek … (2009)

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Incidence and outcomes in acute kidney injury: a comprehensive population-based study.

Tariq Ali, Izhar U.H. Khan, William Simpson … (2007)

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations > or =150 micromol/L (male) or > or =130 micromol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P = 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.

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Author and article information

Contributors

John A Kellum

Norbert Lameire

Journal

Journal ID (nlm-ta): Crit Care

Journal ID (iso-abbrev): Crit Care

Title: Critical Care

Publisher: BioMed Central

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Print): 2013

Publication date (Electronic): 4 February 2013

Publication date PMC-release: 4 February 2014

Volume: 17

Issue: 1

Page: 204

Affiliations

[1 ]The Crisma Center, Department of Critical Care Medicine, 604 Scaife Hall, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA

[2 ]Ghent University Hospital, De Pintelaan 185, Ghent B9000, Belgium

[3 ]KDIGO AKI Guideline Work Group: John A Kellum (Work Group Co-Chair), University of Pittsburgh, PA, USA; Norbert Lameire (Work Group Co-Chair), University of Ghent, Belgium; Peter Aspelin, Karolinska Institute, Sweden; Rashad S Barsoum, Cairo University, Egypt; Emmanuel A Burdmann, University of São Paulo, Brazil; Stuart L Goldstein, Cincinnati Children's Hospital Medical Center, OH, USA; Charles A Herzog, Hennepin County Medical Center, MN, USA; Michael Joannidis, Medical University Innsbruck, Austria; Andreas Kribben, University of Duisburg-Essen, Germany; Andrew S Levey, Tufts University, MA, USA; Alison M Macleod, University of Aberdeen, UK; Ravindra L Mehta, University of California, San Diego, CA, USA; Patrick T Murray, University College Dublin, Ireland; Saraladevi Naicker, University of the Witwatersrand, South Africa; Steven M Opal, Brown University, RI, USA; Franz Schaefer, Heidelberg University Hospital, Germany; Miet Schetz, University of Leuven, Belgium; and Shigehiko Uchino, Jikei University School of Medicine, Japan

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for the KDIGO AKI Guideline Work Group

Article

Publisher ID: cc11454

DOI: 10.1186/cc11454

PMC ID: 4057151

PubMed ID: 23394211

SO-VID: 184a62f2-a8c4-421b-ab75-69cd78aa9022

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Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

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Irish Journal of Paramedicine

Most cited references 126

A positive fluid balance is associated with a worse outcome in patients with acute renal failure

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

Incidence and outcomes in acute kidney injury: a comprehensive population-based study.

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Cited by 819

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