Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai, Carole; Vinsonneau, Christophe; Souweine, Bertrand; Armando, Fabien; Canet, Emmanuel; Clec’h, Christophe; Constantin, Jean-Michel; Darmon, Michaël; Duranteau, Jacques; Gaillot, Théophille; Garnier, Arnaud; Jacob, Laurent; Joannès-Boyau, Olivier; Juillard, Laurent; Journois, Didier; Lautrette, Alexandre; Muller, Laurent; Legrand, Matthieu; Lerolle, Nicolas; Rimmelé, Thomas; Rondeau, Éric; Tamion, Fabienne; Walrave, Yannick; Velly, Lionel; réanimation, Société française d'anesthésie et de; pédiatriques, Groupe francophone de réanimation et urgences; néphrologie, Société française de

doi:10.1186/s13613-016-0145-5

Cited by 56 publications

(49 citation statements)

References 230 publications

(191 reference statements)

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“…It is evident that whenever possible nephrotoxic substances should be replaced by non-nephrotoxic equivalents. On the other hand, essential substances should not be withheld if important for the management of the patient [17]. …”

Section: What Is the Current Standard Of Care?mentioning

confidence: 99%

The intensive care medicine agenda on acute kidney injury

et al. 2017

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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.

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Section: What Is the Current Standard Of Care?mentioning

confidence: 99%

The intensive care medicine agenda on acute kidney injury

et al. 2017

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“…The aim of this systematic review on the prevention and avoidance of further progression of AKI, by core members of the AKI section of the ESICM, is to provide:A critical evaluation of the existing evidenceGive recommendations for clinical practiceUpdate our previously published recommendations [10] and most recent guidelines [2, 11] …”

Section: Introductionmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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“…Im Jahr 2016 hat die Französische Gesellschaft für Anästhesie und Reanimation Leitlinien zur AKI in der perioperativen Periode und in der Intensivstation veröffentlicht [33]. Im Jahr 2017 wurden zusätzlich die aktualisierten Empfehlungen der Europäischen Gesellschaft für Intensivmedizin zur AKIPrävention publiziert [34].…”

Section: Empfehlungen Zur Präventionunclassified

“…In einer kürzlich erschienenen Studie sowie einer Metaanalyse konnte schlussendlich jedoch keine Verringerung der Raten von AKI bzw. Nierenersatztherapie gezeigt werden, weshalb der Einsatz von NAC zur Prävention der kontrastmittelinduzierten AKI nicht mehr empfohlen wird [33,34,81]. Aktuell wird der Effekt von rekombinanter alkalischer Phosphatase auf die AKI in einer Phase-IIb-Studie untersucht, deren Ergebnisse jedoch noch ausstehen [62].…”

Section: Medikamentöse Präventions-maßnahmenunclassified

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

Joannidis

Klein

John

et al. 2018

Med Klin Intensivmed Notfmed

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Die akute Nierenschädigung ("acute kidney injury", AKI) ist ein komplexes Krankheitsbild, das durchschnittlich 50 % der Patienten auf Intensivstationen weltweit betrifft und mit erhöhter Morbidität und Mortalität einhergeht [32,36]. Das Spektrum der AKI reicht von einer Schädigung der Niere ohne Funktionsverlust bis zum Versagen des Organs mit der Notwendigkeit einer Nierenersatztherapie.Über die letzten Jahre wurden Diagnosekriterien für die AKI entwickelt. Die aktuellsten stellen die KDIGO-Leitlinien (KDIGO: "Kidney Disease: Improving Global Outcomes") aus dem Jahr 2012 dar, in denen auch die Klassifikation der AKI geregelt wird.

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Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Cited by 56 publications

References 230 publications

The intensive care medicine agenda on acute kidney injury

The intensive care medicine agenda on acute kidney injury

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

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