Intensive Care Medicine

, Volume 36, Issue 3, pp 392–411 | Cite as

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

Expert opinion of the working group for nephrology, ESICM
  • Michael Joannidis
  • Wilfred Druml
  • Lui G. Forni
  • A. B. Johan Groeneveld
  • Patrick Honore
  • Heleen M. Oudemans-van Straaten
  • Claudio Ronco
  • Marie R. C. Schetz
  • Arend Jan Woittiez
Expert Panel



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


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.


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.


Acute kidney injury Systematic review Recommendations Position paper Prevention Volume expansion Vasopressors Vasodilators Diuretics Hormones APC Renal replacement therapy 

Supplementary material

134_2009_1678_MOESM1_ESM.doc (168 kb)
(DOC 168 kb)


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Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Michael Joannidis
    • 1
  • Wilfred Druml
    • 2
  • Lui G. Forni
    • 3
  • A. B. Johan Groeneveld
    • 4
  • Patrick Honore
    • 5
  • Heleen M. Oudemans-van Straaten
    • 6
  • Claudio Ronco
    • 7
  • Marie R. C. Schetz
    • 8
  • Arend Jan Woittiez
    • 9
  1. 1.Medical Intensive Care Unit, Department of Internal Medicine IMedical University InnsbruckInnsbruckAustria
  2. 2.Department of Internal Medicine IIIUniversity Hospital ViennaViennaAustria
  3. 3.Western Sussex Hospitals Trust, Brighton and Sussex Medical School, University of Sussex BrightonUK
  4. 4.Department of Intensive CareVU Medical CenterAmsterdamThe Netherlands
  5. 5.Department of Intensive Care, Burn CenterQueen Astrid Military HospitalNeder-Over-Heembeek (Brussels)Belgium
  6. 6.Department of Intensive Care MedicineOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  7. 7.Department of Nephrology Dialysis and TransplantationSan Bortolo HospitalVicenzaItaly
  8. 8.Department of Intensive Care MedicineUniversity Hospital, Catholic University LeuvenLeuvenBelgium
  9. 9.Division of Nephrology, Department of MedicineUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands

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