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Prevention of acute kidney injury and protection of renal function in the intensive care unit

Expert opinion of the working group for nephrology, ESICM

  • Expert Panel
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 23 February 2010

Abstract

Background

Acute renal failure on the intensive care unit is associated with significant mortality and morbidity.

Objectives

To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques.

Method

A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system

Conclusions and recommendations

Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Department of Internal Medicine I, Medical University Innsbruck, Anichstasse, 31, 6020, Innsbruck, Austria

    Michael Joannidis

  2. Department of Internal Medicine III, University Hospital Vienna, Vienna, Austria

    Wilfred Druml

  3. Western Sussex Hospitals Trust, Brighton and Sussex Medical School, University of Sussex , Brighton, UK

    Lui G. Forni

  4. Department of Intensive Care, VU Medical Center, Amsterdam, The Netherlands

    A. B. Johan Groeneveld

  5. Department of Intensive Care, Burn Center, Queen Astrid Military Hospital, Neder-Over-Heembeek (Brussels), Belgium

    Patrick Honore

  6. Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Heleen M. Oudemans-van Straaten

  7. Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Viale Rodolfi 37, Vicenza, Italy

    Claudio Ronco

  8. Department of Intensive Care Medicine, University Hospital, Catholic University Leuven, Leuven, Belgium

    Marie R. C. Schetz

  9. Division of Nephrology, Department of Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Arend Jan Woittiez

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This article is discussed in the editorial available at: doi:10.1007/s00134-009-1683-1.

An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-010-1780-1

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Joannidis, M., Druml, W., Forni, L.G. et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit. Intensive Care Med 36, 392–411 (2010). https://doi.org/10.1007/s00134-009-1678-y

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