Published in:
01-05-2020 | Acute Kidney Injury | Editorial
Biomarker of persistent acute kidney injury: another gemstone in the jewelry box
Published in: Intensive Care Medicine | Issue 5/2020
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Acute kidney injury (AKI) is a very common complication of acute illnesses and is associated with poor short- and long-term outcomes [1, 2]. The intensity and timeline of AKI development and recovery can impact these outcomes. Indeed, compared with transient AKI (lasting less than 48 h), persistent AKI (lasting > 48 h and < 7 days) and acute kidney disease (AKD; lasting between 7 and 90 days) are known to be associated with higher mortality and morbidity including de novo or progressive chronic kidney disease [3, 4]. Hence, early identification of patients at risk of persistent AKI and AKD might promote secondary and tertiary preventive measures to improve patient outcomes, respectively (Fig. 1) [5].
Fig. 1
Biomarker integration in the care of patients with acute kidney injury (AKI), and disease (AKD). Footnote: primary preventions include withholding nephrotoxins, adjusting medication doses based on estimated GFR, close monitoring kidney function, optimizing hemodynamic state and avoiding hyperglycemia. Secondary preventions consist of avoiding nephrotoxins, optimizing hemodynamic state, and adding more vigorous hemodynamic monitoring and considering dialysis. Tertiary preventive interventions includes post acute kidney disease care bundle of KAMPS, Kidney function assessment (e.g., measurement of GFR and urine protein), advocacy (e.g., patient and caregiver education, communication with other care providers), medications reconciliation (e.g., assessment of renally excreted and nephrotoxic drugs), pressure (e.g., ensure appropriate blood pressure control and fluid status), sick day protocol (e.g., educating patients about early signs of kidney dysfunction and withholding nephrotoxic drugs in case of acute illness) [5]; WATCH-ME, weight assessment (e.g., frequent monitoring and appropriate management of dry weight), access (e.g., educating patients and care providers regarding how to manage dialysis accesses), Teaching (e.g., educating patients and their caregivers regarding impacts of dialysis and also short- and long-term risks and consequences of acute kidney disease), clearance (e.g., frequent assessment of residual kidney function and dialysis dose), hypotension (e.g., avoiding intra dialysis hypotension and adjusting blood pressure medications as needed), medications reconciliation (e.g., assessment of renally excreted and nephrotoxic drugs) [5]. MAKE90 major acute kidney events at 90 days, RFR renal functional reserve, CKD chronic kidney disease, RRT renal replacement therapy, KAMPS kidney function assessment, advocacy, medications reconciliation, Pressure, Sick day protocol, WATCH-ME weight assessment, access, teaching, clearance, hypotension, medications reconciliation
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