Year in review in Intensive Care Medicine 2010: I. Acute renal failure, outcome, risk assessment and ICU performance, sepsis, neuro intensive care and experimentals

Excerpt

Acute renal failure (or acute kidney injury, AKI) is an important issue in critical care because, as was demonstrated in the past, the patients’ prognosis is dependent on the disturbed renal function. In 2010, four interesting reviews were presented dealing with general, but also with some specific issues of AKI in critically ill patients: One of the utmost important topics in this context is the question if and how AKI may be prevented in patients at risk for developing AKI. The working group within the European Society of Intensive Care Medicine (ESICM) consented on an expert opinion list of recommendations [1]. This work was based on a systematic literature search between 1966 and 2009. Several clinical conditions were elucidated, and optional endpoints were extracted. The studies were graded according to existing guidelines. The most important recommendations are prompt resuscitation of the circulation, the use of vasoactive drugs under strict haemodynamic monitoring and additional measures such as renal replacement therapies (RRT). The problem of hypoalbuminemia and its relation to AKI was part of a special paper presenting a meta-analysis of observational studies [2]. As a result of the lack of clear evidence in this context, the authors provide data from observational studies, with evidence that hypoalbuminemia is a significant independent risk factor both for AKI and for death following AKI development. They conclude that any recommendations regarding optional replacement of human albumin under these conditions are premature, and controlled studies are warranted to assess interventions aimed at correcting hypoalbuminemia. The outcome after AKI in patients with severe burns is the topic of another meta-analysis [3]. The authors describe the prevalence and outcome of this specific patient group, with a three- to six-fold higher mortality for AKI patients. In conclusion, this review clearly shows that AKI remains prevalent and is associated with increased mortality in patients with severe burn injury. Finally, another group of authors discussed the age-related changes, and examined the most frequent aetiologies for renal impairment in the elderly [4]. They conclude that this clinical entity will likely become more common, because of the aging of the population, especially highlighting the methods for prevention of AKI development or worsening in the elderly critically ill patient. …