Table 1 Adaptation of the KDIGO guidelines for treatment of AKI to the postoperative setting

From: Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

ADQI–POQI recommendationsa

KDIGO strength of recommendation

KDIGO grade of evidence

In the absence of haemorrhagic shock, we suggest using a balanced and buffered isotonic crystalloid (e.g. Ringer’s lactate) rather than colloids (albumin or starches) as initial management for expansion of intravascular volume in patients with PO-AKI

Strong

B

We recommend the use of vasopressors in conjunction with fluids in patients with vasomotor shock with PO-AKI

Strong

D

We suggest using protocol-based management of haemodynamic and oxygenation parameters to treat patients with PO-AKI and to prevent worsening of AKI in high-risk patients in the perioperative setting

Strong

D

We suggest insulin therapy targeting plasma glucose <180 mg/dl (10 mmol) in patients with PO-AKI

Weak

Not graded

We suggest not using diuretics to treat AKI, except in the management of volume overload

Strong

A

We recommend not using low-dose dopamine fenoldopam, atrial natriuretic peptide or recombinant human IGF1 to treat AKI

Strong

A

We recommend not using nephrotoxic drugs in patients with PO-AKI unless no suitable, less nephrotoxic alternatives are available or the benefits outweigh the risks

Strong

A

  1. ADQI, Acute Disease Quality Initiative; AKI, acute kidney injury; IGF1, insulin-like growth factor I. KDIGO, Kidney Disease Improving Global Outcomes; PO-AKI, postoperative AKI; POQI, PeriOperative Quality Initiative. aAdapted from the treatment recommendations in the 2012 KDIGO clinical practice guideline for AKI54.
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