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Published in: Intensive Care Medicine 11/2018

01-11-2018 | Focus Editorial

Focus on acute kidney injury 2017

Authors: Miet Schetz, John Prowle

Published in: Intensive Care Medicine | Issue 11/2018

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Excerpt

The treatment and prevention of acute kidney injury (AKI) remains a major challenge to the intensive care physician. In June 2017, ICM dedicated a whole issue to this important clinical syndrome which remains associated with increased short- and long-term morbidity and mortality [1]. In the current editorial, we focus on recent papers handling the pathophysiology, prevention and supportive treatment of AKI during critical illness, highlighting publications from ICM in the last year (Table 1).
Table 1
Questions addressed by original trials related to AKI and published in ICM in 2017
Question
Answer
Does contrast administration for CT imaging increase the risk of AKI?
Analysis of propensity-matched populations shows no increased risk [2, 3]
Can AKI be predicted with clinically available data?
An AKI predictor using only clinically available data provides moderate prediction of AKI and outperforms NGAL on admission [5]
Can application of a KDIGO care bundle reduce the incidence of AKI after cardiac surgery?
In an at-risk population defined by an increased level of a marker of cell-cycle arrest, application of a KDIGO care bundle decreases the incidence of AKI after cardiac surgery [7, 8]
Does a chloride-rich fluid strategy increase the risk of AKI after cardiac surgery
The change to post-operative peak creatinine after cardiac surgery does not differ between a chloride-rich and a chloride-limited fluid strategy [11]
Are quality indicators of CRRT adequately defined?
A systematic review shows quality indicators for CRRT are poorly defined and evaluated [14]
Literature
1.
go back to reference Bellomo R, Vaara ST, Kellum JA (2017) How to improve the care of patients with acute kidney injury. Intensive Care Med 43:727–729CrossRef Bellomo R, Vaara ST, Kellum JA (2017) How to improve the care of patients with acute kidney injury. Intensive Care Med 43:727–729CrossRef
2.
go back to reference McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K (2017) Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med 43:774–784CrossRef McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K (2017) Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med 43:774–784CrossRef
3.
go back to reference Ehrmann S, Quartin A, Hobbs BP, Robert-Edan V, Cely C, Bell C, Lyons G, Pham T, Schein R, Geng Y, Lakhal K, Ng CS (2017) Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med 43:785–794CrossRef Ehrmann S, Quartin A, Hobbs BP, Robert-Edan V, Cely C, Bell C, Lyons G, Pham T, Schein R, Geng Y, Lakhal K, Ng CS (2017) Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med 43:785–794CrossRef
4.
go back to reference Joannidis M, Druml W, Forni LG, Groeneveld ABJ, Honore PM, Hoste E, Ostermann M, Oudemans-van Straaten HM, Schetz M (2017) Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med 43:730–749CrossRef Joannidis M, Druml W, Forni LG, Groeneveld ABJ, Honore PM, Hoste E, Ostermann M, Oudemans-van Straaten HM, Schetz M (2017) Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med 43:730–749CrossRef
5.
go back to reference Flechet M, Guiza F, Schetz M, Wouters P, Vanhorebeek I, Derese I, Gunst J, Spriet I, Casaer M, Van den Berghe G, Meyfroidt G (2017) AKIpredictor, an online prognostic calculator for acute kidney injury in adult critically ill patients: development, validation and comparison to serum neutrophil gelatinase-associated lipocalin. Intensive Care Med 43:764–773CrossRef Flechet M, Guiza F, Schetz M, Wouters P, Vanhorebeek I, Derese I, Gunst J, Spriet I, Casaer M, Van den Berghe G, Meyfroidt G (2017) AKIpredictor, an online prognostic calculator for acute kidney injury in adult critically ill patients: development, validation and comparison to serum neutrophil gelatinase-associated lipocalin. Intensive Care Med 43:764–773CrossRef
6.
go back to reference Prowle JR, Rosner MH (2017) Have biomarkers failed in acute kidney injury? We are not sure. Intensive Care Med 43:890–892CrossRef Prowle JR, Rosner MH (2017) Have biomarkers failed in acute kidney injury? We are not sure. Intensive Care Med 43:890–892CrossRef
7.
go back to reference Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A (2017) Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med 43:1551–1561CrossRef Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A (2017) Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med 43:1551–1561CrossRef
8.
go back to reference Prowle JR, Schetz M (2017) Validating benefit of biomarker-directed therapy for acute kidney injury: can you have your cake and eat it? Intensive Care Med 43:578–580CrossRef Prowle JR, Schetz M (2017) Validating benefit of biomarker-directed therapy for acute kidney injury: can you have your cake and eat it? Intensive Care Med 43:578–580CrossRef
9.
go back to reference Perner A, Prowle J, Joannidis M, Young P, Hjortrup PB, Pettila V (2017) Fluid management in acute kidney injury. Intensive Care Med 43:807–815CrossRef Perner A, Prowle J, Joannidis M, Young P, Hjortrup PB, Pettila V (2017) Fluid management in acute kidney injury. Intensive Care Med 43:807–815CrossRef
10.
go back to reference Schortgen F, Schetz M (2017) Does this critically ill patient with oliguria need more fluids, a vasopressor, or neither? Intensive Care Med 43:907–910CrossRef Schortgen F, Schetz M (2017) Does this critically ill patient with oliguria need more fluids, a vasopressor, or neither? Intensive Care Med 43:907–910CrossRef
11.
go back to reference McIlroy D, Murphy D, Kasza J, Bhatia D, Wutzlhofer L, Marasco S (2017) Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial. Intensive Care Med 43:795–806CrossRef McIlroy D, Murphy D, Kasza J, Bhatia D, Wutzlhofer L, Marasco S (2017) Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial. Intensive Care Med 43:795–806CrossRef
12.
go back to reference Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, Stollings JL, Kumar AB, Hughes CG, Hernandez A, Guillamondegui OD, May AK, Weavind L, Casey JD, Siew ED, Shaw AD, Bernard GR, Rice TW, SMART Investigators and the Pragmatic Critical Care Research Group (2018) Balanced crystalloids versus saline in critically ill adults. N Engl J Med 378:829–839CrossRef Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, Stollings JL, Kumar AB, Hughes CG, Hernandez A, Guillamondegui OD, May AK, Weavind L, Casey JD, Siew ED, Shaw AD, Bernard GR, Rice TW, SMART Investigators and the Pragmatic Critical Care Research Group (2018) Balanced crystalloids versus saline in critically ill adults. N Engl J Med 378:829–839CrossRef
13.
go back to reference Bagshaw SM, Darmon M, Ostermann M, Finkelstein FO, Wald R, Tolwani AJ, Goldstein SL, Gattas DJ, Uchino S, Hoste EA, Gaudry S (2017) Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury. Intensive Care Med 43:841–854CrossRef Bagshaw SM, Darmon M, Ostermann M, Finkelstein FO, Wald R, Tolwani AJ, Goldstein SL, Gattas DJ, Uchino S, Hoste EA, Gaudry S (2017) Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury. Intensive Care Med 43:841–854CrossRef
14.
go back to reference Rewa OG, Villeneuve PM, Lachance P, Eurich DT, Stelfox HT, Gibney RTN, Hartling L, Featherstone R, Bagshaw SM (2017) Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review. Intensive Care Med 43:750–763CrossRef Rewa OG, Villeneuve PM, Lachance P, Eurich DT, Stelfox HT, Gibney RTN, Hartling L, Featherstone R, Bagshaw SM (2017) Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review. Intensive Care Med 43:750–763CrossRef
15.
go back to reference Pickkers P, Ostermann M, Joannidis M, Zarbock A, Hoste E, Bellomo R, Prowle J, Darmon M, Bonventre JV, Forni L, Bagshaw SM, Schetz M (2017) The intensive care medicine agenda on acute kidney injury. Intensive Care Med 43:1198–1209CrossRef Pickkers P, Ostermann M, Joannidis M, Zarbock A, Hoste E, Bellomo R, Prowle J, Darmon M, Bonventre JV, Forni L, Bagshaw SM, Schetz M (2017) The intensive care medicine agenda on acute kidney injury. Intensive Care Med 43:1198–1209CrossRef
Metadata
Title
Focus on acute kidney injury 2017
Authors
Miet Schetz
John Prowle
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 11/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5357-8

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