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Title: The Intensive care medicine agenda on acute kidney injury
Austin Authors: Pickkers, Peter;Ostermann, Marlies;Joannidis, Michael;Zarbock, Alexander;Hoste, Eric;Bellomo, Rinaldo ;Prowle, John;Darmon, Michael;Bonventre, Joseph V;Forni, Lui;Bagshaw, Sean M;Schetz, Miet
Affiliation: Department of Intensive care medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
Department of Critical Care, Guy's and St Thomas' Hospital, King's College London, London, UK
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Münster, Münster, Germany
Department of Intensive care medicine, Ghent University Hospital, Ghent, Belgium
Research Foundation-Flanders, Brussels, Belgium
School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
William Harvey Research Institute, Queen Mary University of London, London, UK
Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
Medical-Surgical ICU, Saint-Etienne University Hospital and Jacques Lisfranc Medical School, Saint-Etienne, France
Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Surrey Perioperative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital, NHS Foundation Trust and School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Egerton Road, Guildford, UK
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Clinical Department and Laboratory of Intensive care medicine, Division of Cellular and Molecular Medicine, KU Leuven University, Louvain, Belgium
Issue Date: Sep-2017 2017-01-30
Publication information: Intensive Care Medicine 2017; 43(9): 1198-1209
Abstract: Acute kidney injury (AKI) is a common complication in the critically ill. Current standard of care mainly relies on identification of patients at risk, haemodynamic optimization, avoidance of nephrotoxicity and the use of renal replacement therapy (RRT) in established AKI. The detection of early biomarkers of renal tissue damage is a recent development that allows amending the late and insensitive diagnosis with current AKI criteria. Increasing evidence suggests that the consequences of an episode of AKI extend long beyond the acute hospitalization. Citrate has been established as the anticoagulant of choice for continuous RRT. Conflicting results have been published on the optimal timing of RRT and on the renoprotective effect of remote ischaemic preconditioning. Recent research has contradicted that acute tubular necrosis is the common pathology in AKI, that septic AKI is due to global kidney hypoperfusion, that aggressive fluid therapy benefits the kidney, that vasopressor therapy harms the kidney and that high doses of RRT improve outcome. Remaining uncertainties include the impact of aetiology and clinical context on pathophysiology, therapy and prognosis, the clinical benefit of biomarker-driven interventions, the optimal mode of RRT to improve short- and long-term patient and kidney outcomes, the contribution of AKI to failure of other organs and the optimal approach for assessing and promoting renal recovery. Based on the established gaps in current knowledge the trials that must have priority in the coming 10 years are proposed together with the definition of appropriate clinical endpoints.
DOI: 10.1007/s00134-017-4687-2
ORCID: 0000-0002-1650-8939
PubMed URL:
Type: Journal Article
Subjects: Acute kidney injury
Fluid therapy
Renal replacement therapy
Research agenda
Trial endpoints
Appears in Collections:Journal articles

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