[Acute Kidney Injury in the Intensive Care Unit - What is New?]

Acute kidney injury (AKI) can be considered as an inflammatory systemic disorder affecting virtually every organ. It has great impact on morbidity and mortality of critically ill patients.

The use of electronic alerts for detection of AKI combined with the use of standardized kidney care bundles can improve patient outcomes. Currently, it is important to find ways to implement these in everyday clinical practice.

Volume replacement therapy should always be carried out with balanced solutions. The use of 0.9 % NaCl solution should be avoided. In individual cases, patients can also benefit from a colloidal solution in the form of human albumin. Urgently indicated radiographic diagnosis with iodine-containing contrast agent should not be delayed or canceled due to renal impairment. The prophylactic measures in this context are not different from the general recommendations in AKI (achieve euvolemia, avoid nephrotoxins), specific measures do not exist. Indiscriminate hydration of non-hypovolemic patients has no advantages and is associated with an increased risk of cardiac decompensation and AKI.

Treatment dose and modality should be adapted to the clinical needs of the patient. The recommended dose of 20 - 25 ml/kg/h serves as orientation. Continuous and intermittent therapies should be available. Regional citrate anticoagulation (RCA) can also be safely used for patients with liver damage or lactic acidosis, provided that early signs of citrate accumulation are closely monitored. In the case of lactic acidosis, lactate clearance rather than baseline level of lactate is particularly important for the risk of citrate accumulation.