Protocoled resuscitation and the prevention of acute kidney injury

Acute kidney injury (AKI) occurrence in critically ill patients is common and is associated with a substantial increase in morbidity and mortality. The scope of this review is to summarize the most recent evidence-based knowledge for prevention of AKI.

Recent recommendations for prevention of AKI in ICU patients are all 'negative' and, similarly, the most recent and updated guidelines about major topic areas of interest for AKI, including definition and classification, prevention, and pharmacologic treatment, have failed to identify single evidence-based recommendations for prevention and treatment of AKI. Therefore, the evaluation and management of AKI should be guided by clinical algorithms aiming to protocolized hemodynamic optimization, metabolic control, monitoring of intra-abdominal hypertension, use of diuretics to control fluid overload, and careful management of nephrotoxic factors.

Key components of optimal AKI prevention include maintenance of renal perfusion and avoidance of precipitating factors. Adequate renal blood flow maintenance is the first strategy to employ not only to assure renal oxygenation, but also to prevent nephrotoxic drugs-associated AKI. Many potential therapies and interventions are on the horizon, but most of the future research will need to focus more on a step-wise, protocoled, kidney-oriented approach, than on single treatments.