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Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine

Joannidis, M., Druml, W., Forni, L.G., Groeneveld, A.B.J., Honore, P.M., Hoste, E., Ostermann, M., Oudemans‑van Straaten, H.M. and Schetz, M. (2017) Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine Intensive Care Medicine, 43 (6). pp. 730-749.

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Abstract


Background:

Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.


Objectives:

To 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.


Method:

A 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.


Results:

We 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.


Conclusion:

The 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.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Joannidis, M.
Druml, W.
Forni, L.G.l.forni@surrey.ac.uk
Groeneveld, A.B.J.
Honore, P.M.
Hoste, E.
Ostermann, M.
Oudemans‑van Straaten, H.M.
Schetz, M.
Date : 2 June 2017
DOI : 10.1007/s00134-017-4832-y
Copyright Disclaimer : © 2017 The Author(s). This article is an open access publication This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Uncontrolled Keywords : Acute kidney injury; Systematic review Recommendations; Prevention; Volume expansion; Vasopressors
Depositing User : Diane Maxfield
Date Deposited : 10 Oct 2019 16:05
Last Modified : 10 Oct 2019 16:05
URI: http://epubs.surrey.ac.uk/id/eprint/852728

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