Search

The Acute Kidney Injury Network (AKIN) met in Amsterdam, The Netherlands, in September 2005. At the 2-day meeting, participants in this multidisciplinary collaboration proposed a standard definition, and scheme for the classification, of AKI. Widespread adoption of these standards, presented here by members of the AKIN working group, would help to advance the study of this condition, and improve patient outcomes.

Here, the authors describe the spectrum and global burden of AKI. They discuss the knowledge and practice gaps that must be addressed to improve AKI care and outline a framework for creating a sustainable infrastructure to address this global health issue.

A recent report suggests that the incidence of acute kidney injury (AKI) in patients with acute myocardial infarction declined between 2000 and 2008 and was associated with decreased mortality despite concurrent increases in comorbidities. Although encouraging, changing patterns of care and an understanding of factors contributing to AKI in this setting must be considered.

Several studies have indicated that an intensive continuous renal replacement therapy (CRRT) dose has no benefit over a standard CRRT dose. However, treatment-related factors may have influenced these findings. In this article, Macedo et al. discuss the assumption that delivered dialysis dose is equivalent to the effluent volume and highlight the importance of assessing filter efficacy and dose parameters in patients receiving CRRT.

In 2013, four important papers were published that provide new insights on biomarkers in acute kidney injury (AKI). These studies demonstrate the potential for biomarkers to aid clinicians in improving the therapeutic management of patients with AKI and potentially improve patient outcomes.

Ralib et al. report that urine output (UO) <0.3 ml/kg/h for >6 h predicts a composite outcome of mortality and dialysis requirement in critically ill patients. Their findings validate UO as a marker of acute kidney injury, but raise the question of whether the diagnostic thresholds should be more stringent.

World Kidney Day will be celebrated on March 14 2013, and this year, aims to increase awareness of the global increase in acute kidney injury (AKI). An urgent need exists for a global health strategy to reduce the burden of AKI; efforts focused on preventing AKI should be coupled with early detection, treatment, and follow-up strategies.

Approaches to effectively prevent and manage organ dysfunction in critically ill patients remain elusive. Key studies in 2016 highlighted the challenges in finding effective treatments for renal failure in sepsis and assessed the optimal timing of renal replacement therapy initiation in critically ill patients with acute kidney injury.

Over the past decade remote ischaemic preconditioning (RIPC) has evolved as a promising strategy to reduce ischaemia in remote organs. Although previous studies using surrogate outcomes have encouraged further investigation, two recent randomized controlled trials — the ERICCA trial and the RIPHeart Study — were unable to detect a protective effect of RIPC.

Pregnancy-associated acute kidney injury is a risk factor for maternal and fetal morbidity and mortality and a driver of health inequity worldwide. This Consensus Statement from the Acute Disease Quality Initiative provides recommendations on the causes, diagnosis, management and follow-up of pregnancy-associated acute kidney injury.

Timing of dialysis initiation in critically ill patients is controversial. The STARRT-AKI trial reports that an accelerated initiation strategy did not improve 90-day survival and increased dialysis dependency compared with a standard approach in which patients had greater fluid accumulation and metabolic complications at initiation but 38% avoided dialysis.

Acute kidney injury (AKI) and chronic kidney disease are increasingly recognized as interconnected entities and the term acute kidney disease (AKD) has been proposed to define ongoing pathophysiologic processes following an episode of AKI. In this Consensus statement, the Acute Disease Quality Initiative 16 Workgroup propose definitions and staging criteria for AKD, and strategies for the management of affected patients. They also make recommendations for areas of future research with the aims of improving understanding of the underlying processes and improving outcomes.

COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and is an independent risk factor for all-cause in-hospital death in patients with COVID-19. This Consensus Statement from the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI and for areas of future research, with the aim of improving understanding of the underlying processes and outcomes for patients with COVID-19 AKI.

Several factors complicate the identification of effective interventions that can improve the outcomes of patients with acute kidney injury (AKI). Here, the authors discuss key design considerations for clinical trials in hospitalized patients with AKI, including the selection of adequate patient cohorts and study end points.

Sepsis-associated acute kidney injury (SA-AKI) is linked with poor outcomes in critically ill patients. This Consensus Statement from the Acute Disease Quality Initiative discusses the definition, epidemiology and pathophysiology of SA-AKI, fluid, resuscitation and extracorporeal therapies, and the role of biomarkers in risk stratification and diagnosis.

In this Consensus Statement, the authors discuss a framework for the development, validation and implementation of digital health technologies across the acute kidney injury continuum — risk prediction, prevention, detection and management.

The development of acute kidney injury (AKI) after major non-cardiac surgery is associated with substantial long-term morbidity and mortality. This joint Consensus Statement from the Acute Disease Quality Initiative and the PeriOperative Quality Initiative provides recommendations for the definition, prevention and management of postoperative AKI.