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ACUTE KIDNEY INJURY IN 2020

Tackling AKI: prevention, timing of dialysis and follow-up

Nature Reviews Nephrology volume 17, pages 87–88 (2021)Cite this article

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Timely diagnosis and dialytic treatment of acute kidney injury (AKI) came to the forefront at the height of the coronavirus disease 2019 pandemic as admissions surged in intensive care units. Research on early diagnosis, timing of initiation of kidney replacement therapy, and appropriate post-hospitalization patient care remains essential to tackling the burden of AKI.

Key advances

  • Individuals with type 2 diabetes mellitus (T2DM) are at significantly higher risk of acute kidney injury (AKI) than those without T2DM, independent of underlying chronic kidney disease.

  • In patients undergoing cardiac surgery, elevated levels of anti-angiogenic factor vascular endothelial growth factor receptor 1 are associated with a higher risk of AKI and mortality; biomarkers for early diagnosis of AKI remain a work in progress.

  • The STARRT-AKI trial demonstrated that early initiation of kidney replacement therapy for patients with AKI in intensive care units did not improve outcomes and was associated with a higher risk of hypotension and hypophosphatemia.

  • Albuminuria at 90 days after a hospitalization complicated by AKI is a strong predictor of progressive decline in kidney function.

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Fig. 1: Approach to the management of patients with acute kidney injury.

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Authors and Affiliations

  1. Division of Nephrology, Washington University in St. Louis, St. Louis, MO, USA

    Anitha Vijayan

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  1. Anitha Vijayan
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Correspondence to Anitha Vijayan.

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A.V. consults for NxStage Inc. and Astute Medical.

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Vijayan, A. Tackling AKI: prevention, timing of dialysis and follow-up. Nat Rev Nephrol 17, 87–88 (2021). https://doi.org/10.1038/s41581-020-00390-3

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