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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2010

01-03-2010 | Expert Panel

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

Expert opinion of the working group for nephrology, ESICM

Authors: 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

Published in: Intensive Care Medicine | Issue 3/2010

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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.
Appendix
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Metadata
Title
Prevention of acute kidney injury and protection of renal function in the intensive care unit
Expert opinion of the working group for nephrology, ESICM
Authors
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
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1678-y

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