Skip to main content

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

Abstract

Acute kidney injury (AKI) is a frequent finding in critically ill patients and associated with adverse outcomes, such as increased length of stay, end-stage-renal disease (ESRD) and mortality [1, 2]. Approximately 50 % of ICU patients have AKI as defined by the sensitive RIFLE definition, and 5–15 % of ICU patients are treated with renal replacement therapy (RRT). Several new concepts, encompassing practically all aspects of AKI from diagnosis to treatment and outcome, have evolved over the last few years. This overview describes the most important new insights on AKI, based on recent research and consensus reports.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hoste EA, De Corte W (2007) Epidemiology of AKI in the ICU. Acta Clin Belg Suppl 2:314–317

    Article  PubMed  Google Scholar 

  2. Hoste EA, Schurgers M (2008) Epidemiology of acute kidney injury: how big is the problem? Crit Care Med 36(4):S146–S151

    Article  PubMed  Google Scholar 

  3. Ronco C, Kellum JA, Haase M (2012) Subclinical AKI is still AKI. Crit Care 16:313

    Article  PubMed  Google Scholar 

  4. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Workgroup A (2004) Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212

    Article  PubMed  Google Scholar 

  5. Mehta RL, Kellum JA, Shah SV et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31

    Article  PubMed  Google Scholar 

  6. KDIGO Clinical Practice Guideline for Acute Kidney Injury (2012) Kid Int Suppl 2:16–39

    Google Scholar 

  7. Hoste EA, Clermont G, Kersten A et al (2006) RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10:R73

    Article  PubMed  Google Scholar 

  8. Ostermann M, Chang R, Riyadh ICUPUG (2008) Correlation between the AKI classification and outcome. Crit Care 12:R144

    Article  PubMed  Google Scholar 

  9. Mandelbaum T, Scott DJ, Lee J et al (2011) Outcome of critically ill patients with acute kidney injury using the Acute Kidney Injury Network criteria. Crit Care Med 39:2659–2664

    PubMed Central  PubMed  Google Scholar 

  10. Bihorac A, Brennan M, Ozrazgat-Baslanti T et al (2013) National surgical quality improvement program underestimates the risk associated with mild and moderate postoperative acute kidney injury. Crit Care Med 41:2570–2583

    Article  PubMed  Google Scholar 

  11. Marik PE (2006) Management of the critically ill geriatric patient. Crit Care Med 34:176–182

    Article  Google Scholar 

  12. McDermid RC, Stelfox HT, Bagshaw SM (2011) Frailty in the critically ill: a novel concept. Crit Care 15:301

    Article  PubMed  Google Scholar 

  13. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  Google Scholar 

  14. Cook WL (2009) The intersection of geriatrics and chronic kidney disease: frailty and disability among older adults with kidney disease. Adv Chronic Kidney Dis 16:420–429

    Article  PubMed  Google Scholar 

  15. Bagshaw SM, George C, Bellomo R, Committee ADM (2007) Changes in the incidence and outcome for early acute kidney injury in a cohort of Australian intensive care units. Crit Care 11:R68

    Article  PubMed  Google Scholar 

  16. Waikar SS, Wald R, Chertow GM et al (2006) Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for acute renal failure. J Am Soc Nephrol 17:1688–1694

    Article  PubMed  Google Scholar 

  17. Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818

    Article  CAS  PubMed  Google Scholar 

  18. Nisula S, Kaukonen KM, Vaara ST et al (2013) Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med 39:420–428

    Article  PubMed  Google Scholar 

  19. Rosner MH, Ronco C, Okusa MD (2012) The role of inflammation in the cardio-renal syndrome: a focus on cytokines and inflammatory mediators. Semin Nephrol 32:70–78

    Article  CAS  PubMed  Google Scholar 

  20. McCullough PA, Kellum JA, Haase M et al (2013) Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:82–98

    Article  PubMed  Google Scholar 

  21. Levy EM, Viscoli CM, Horwitz RI (1996) The effect of acute renal failure on mortality. A cohort analysis. JAMA 275:1489–1494

    Article  CAS  PubMed  Google Scholar 

  22. Kellum JA, Bellomo R, Ronco C (2012) Kidney attack. JAMA 307:2265–2266

    Article  CAS  PubMed  Google Scholar 

  23. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370

    Article  PubMed  Google Scholar 

  24. Goldstein SL, Chawla LS (2010) Renal angina. Clin. J Am Soc Nephrol 5:943–949

    Article  Google Scholar 

  25. Kashani K, Al-Khafaji A, Ardiles T et al (2013) Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care 17:R25

    Article  PubMed  Google Scholar 

  26. Arthur JM, Hill EG, Alge JL et al (2013) Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery. Kidney Int (in press)

    Google Scholar 

  27. Colpaert K, Hoste EA, Steurbaut K et al (2012) Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class. Crit Care Med 40:1164–1170

    Article  PubMed  Google Scholar 

  28. Lin SM, Huang CD, Lin HC, Liu CY, Wang CH, Kuo HP (2006) A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: a randomized controlled trial. Shock 26:551–557

    Article  PubMed  Google Scholar 

  29. Wan L, Bagshaw SM, Langenberg C, Saotome T, May C, Bellomo R (2008) Pathophysiology of septic acute kidney injury: what do we really know? Crit Care Med 36(4):198–203

    Article  Google Scholar 

  30. De Waele JJ, De Laet I, Kirkpatrick AW, Hoste E (2011) Intra-abdominal Hypertension and Abdominal Compartment Syndrome. Am J Kidney Dis 57:159–169

    Article  PubMed  Google Scholar 

  31. De Corte W, Vanholder R, Dhondt AW et al (2011) Serum urea concentration is probably not related to outcome in ICU patients with AKI and renal replacement therapy. Nephrol Dial Transplant 26:3211–3218

    Article  PubMed  Google Scholar 

  32. Seabra VF, Balk EM, Liangos O, Sosa MA, Cendoroglo M, Jaber BL (2008) Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis. Am J Kidney Dis 52:272–284

    Article  PubMed  Google Scholar 

  33. Karvellas CJ, Farhat MR, Sajjad I et al (2011) A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 15:R72

    Article  PubMed  Google Scholar 

  34. Bellomo R, Cass A, Norton R et al (2009) Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 361:1627–1638

    Article  PubMed  Google Scholar 

  35. Bagshaw SM, Laupland KB, Doig CJ et al (2005) Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 9:R700–R709

    Article  PubMed  Google Scholar 

  36. Korkeila M, Ruokonen E, Takala J (2000) Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 26:1824–1831

    Article  CAS  PubMed  Google Scholar 

  37. Ahlstrom A, Tallgren M, Peltonen S, Rasanen P, Pettila V (2005) Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med 31:1222–1228

    Article  PubMed  Google Scholar 

  38. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53:961–973

    Article  PubMed Central  PubMed  Google Scholar 

  39. Fuchs L, Lee J, Baumfeld Y, Novack V et al (2013) Severity of acute kidney injury and two-year outcomes in critically ill patients. Chest 144:866–875

    Article  PubMed  Google Scholar 

  40. Cordoba G, Schwartz L, Woloshin S, Bae H, Gotzsche PC (2010) Definition, reporting, and interpretation of composite outcomes in clinical trials: systematic review. BMJ 341:c3920

    Article  PubMed Central  PubMed  Google Scholar 

  41. Palevsky PM, Molitoris BA, Okusa MD et al (2012) Design of clinical trials in acute kidney injury: report from an NIDDK workshop on trial methodology. Clin. J Am Soc Nephrol 7:844–850

    Article  Google Scholar 

  42. Chawla LS, Kimmel PL (2012) Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 82:516–524

    Article  PubMed  Google Scholar 

  43. Amdur RL, Chawla LS, Amodeo S, Kimmel PL, Palant CE (2009) Outcomes following diagnosis of acute renal failure in U.S. veterans: focus on acute tubular necrosis. Kidney Int 76:1089–1097

    Article  PubMed  Google Scholar 

  44. Ishani A, Xue JL, Himmelfarb J et al (2009) Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 20:223–228

    Article  PubMed  Google Scholar 

  45. Rimes-Stigare C, Awad A, Martensson J, Martling CR, Bell M (2012) Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesthesiol Scand 56:138–146

    Article  CAS  PubMed  Google Scholar 

  46. Chertow GM, Christiansen CL, Cleary, Munro C, Lazarus JM (1995) Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 155:1505–1511

    Article  CAS  PubMed  Google Scholar 

  47. Schiffl H, Fischer R (2008) Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transpl 23:2235–2241

    Article  Google Scholar 

  48. Bell M, Swing, Granath F, Schon S, Ekbom A, Martling CR (2007) Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med 33:773–780

    Article  PubMed  Google Scholar 

  49. Singbartl K, Kellum JA (2012) AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 81:819–825

    Article  CAS  PubMed  Google Scholar 

  50. Pannu N, James M, Hemmelgarn B, Klarenbach S, Kidney Disease AN (2013) Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol 8:194–202

    Article  PubMed  Google Scholar 

  51. Bell M (2008) Acute kidney injury: new concepts, renal recovery. Nephron Clin Pract 109:c224–c228

    Article  PubMed  Google Scholar 

  52. Oeyen S, Vandijck D, Benoit D, Decruyenaere J, Annemans L, Hoste E (2007) Long-term outcome after acute kidney injury in critically-ill patients. Acta Clin Belg Suppl 2:337–340

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to W. De Corte .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

De Corte, W., De Laet, I., Hoste, E. (2014). Shifting Paradigms in Acute Kidney Injury. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-03746-2_40

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03745-5

  • Online ISBN: 978-3-319-03746-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics