Tackling AKI: prevention, timing of dialysis and follow-up

Abstract

Timely diagnosis and dialytic treatment of acute kidney injury (AKI) came to the forefront at the height of the coronavirus disease 2019 pandemic as admissions surged in intensive care units. Research on early diagnosis, timing of initiation of kidney replacement therapy, and appropriate post-hospitalization patient care remains essential to tackling the burden of AKI.

Fig. 1. Approach to the management of patients with acute kidney injury.

Risk factors that predispose patients to acute kidney injury (AKI) include sepsis, coronavirus disease 2019 (COVID-19) and exposure to nephrotoxins. In addition, underlying co-morbidities such as type 2 diabetes mellitus (T2DM) and hypertension (HTN) can further increase the risk of AKI. For the majority of patients, AKI will not be severe and kidney replacement therapy (KRT) will not be required, although careful post-hospitalization care remains essential to prevent recurrent AKI. In patients with severe AKI (stage 3), careful consideration must be given to the timing of KRT to optimize kidney recovery and reduce the need for long-term KRT. ACE, angiotensin-converting enzyme; ARBs, angiotensin II receptor blockers; STARRT-AKI, Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI; UACR, urinary albumin-to-creatinine ratio.