[Prevention of acute kidney injury]

Abstract

Acute kidney injury contributes significantly to morbidity and mortality in hospitalized patients and is a common complication in the intensive care unit. Identification of patients at risk, elimination of modifiable risk factors and initiation of recommended preventive measures are the main cornerstones to prevent the onset and progression of acute kidney injury. Clinical and biomarker-based risk scores can help assess AKI-risk in specific patient populations. To date, there is no approved clinically effective drug to prevent AKI. Current guidelines suggest preventive care bundles that include optimizing volume status and renal perfusion by improving mean arterial pressure and using vasopressors, mainly norepinephrine. In addition, avoidance of volume overload and the targeted use of diuretics to achieve euvolemia are recommended. Nephrotoxic drugs require a critical risk-benefit assessment and therapeutic drug monitoring when appropriate. Contrast imaging should not be withheld from patients at risk of AKI when indicated but contrast medium should be limited to the smallest possible volume. Finally, recommendations include maintenance of normoglycemia and other measures to optimize organ function in specific patient populations.