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Review
. 2025 Jul;51(7):1331-1347.
doi: 10.1007/s00134-025-08015-8. Epub 2025 Jul 15.

Preventing acute kidney injury and its longer-term impact in the critically ill

Alexander Zarbock  1   2 , Lui Forni  3 , Jay L Koyner  4 , Hernando Gómez  5 , Neesh Pannu  6 , Marlies Ostermann  7 , Rinaldo Bellomo  8 , John A Kellum  5 , Thilo von Groote  9
Affiliations
Review

Preventing acute kidney injury and its longer-term impact in the critically ill

Alexander Zarbock et al. Intensive Care Med. 2025 Jul.

Abstract

Acute kidney injury (AKI) is a heterogeneous syndrome that not only affects short-term morbidity and mortality but also influences long-term outcomes. AKI is part of acute kidney disease (AKD) that encompasses a range of different conditions and is characterized by a kidney dysfunction lasting 90 days or less after which time the term chronic kidney disease (CKD) applies. AKD may result in irreversible loss of nephrons and may lead to CKD. In this narrative review, an update on different aspects of AKI in critically ill patients will be provided. We discuss biomarkers for early diagnosis of AKI, sub-clinical AKI, as well as AKI-AKD-CKD transition. In addition, various strategies to prevent the development of AKI, including the application of amino acids, remote-ischemic preconditioning, hemoadsorption, and a kidney prevention strategy, will be discussed. Finally, the choice of adequate endpoints for AKI prevention trials will be addressed."Take home message".AKI and even subclinical AKI impact short- and long-term outcome and therefore, prevention of kidney injury is of utmost importance. As several strategies have been proven to be effective in preventing the development of AKI, these therapies should be implemented in daily practice to improve patient outcomes.

Keywords: Acute kidney disease; Acute kidney injury; Biomarkers; Chronic kidney disease; Preventive strategy.

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Conflict of interest statement

Declarations. Conflicts of interest: AZ has received lecture and consultancy fees from Baxter, Fresenius, BioMerieux, Viatris, Guard Therapeutics, Novartis, Paion, AM Pharma, Alexion, Renibus, and Bayer as well as an unrestricted research grants from Baxter and BioMerieux. JLK received consulting fees from Alexion, Astute-Biomerieux, Baxter, Bioporto, Seastar, Novartis, Guard Therapeutics and research Funding from NIH, Astute Medical-Biomerieux, Bioporto, Fresenius Medical. JAK is a full-time employee of Spectral Medical and holds stock in the company. He also discloses consulting fees paid by AstraZeneca, Bayer, bioMérieux, Chugai Pharma, Mitsubishi Tenabe, and Novartis. MO has received research funding from Baxter and Biomerieux (paid to institution). LF, HG, NP, RB, and TvG have no conflict of interests.

Figures

Fig. 1
Fig. 1
represents a paradigm where AKI is categorized based on the potential elevation of damage and functional biomarkers. Patients can have elevations in neither, one or both types of biomarkers and can traverse the 2 × 2 table horizontally and vertically over time. Patients with elevation in biomarkers in the absence of changes in functional biomarkers (SCr and/or UOP) have “subclinical AKI.” Modified with permission from [7]
Fig. 2
Fig. 2
AKI, AKD and CKD as interconnected and partly overlapping syndromes. Three pathways might lead to CKD: 1) AKI-AKD-CKD (solid lines) 2) AKI-CKD (dashed lines) 3) AKD-CKD (dotted lines). Acute kidney injury, AKI, acute kidney disease, AKD; chronic kidney injury, CKD
See this image and copyright information in PMC

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