Materiały źródłowe

• #1 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. […] Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances. […] Team-based approaches for prevention, early diagnosis, and aggressive management are critical for improving outcomes. […] Because of the morbidity and mortality associated with acute kidney injury, it is important for primary care physicians to identify patients who are at high risk of developing this type of injury and to implement preventive strategies. […] Preventive strategies can be tailored to the clinical circumstances of the individual patient.

• #2 Researchers Reveal Target in Acute Kidney Injury Prevention | Rush

  https://www.rush.edu/news/researchers-reveal-target-acute-kidney-injury-prevention

  Up to 10% of patients who are hospitalized or undergo surgery will experience acute kidney injury (AKI), and as many as 50% of patients in intensive care units will meet the criteria for AKI, the National Kidney Foundation has determined. […] Researchers at Rush University Medical Center, in collaboration with colleagues at other institutions, have revealed a new treatment target that may help change the outcome for patients at risk of AKI. […] In this study, we found evidence that a specific protein produced by immune cells in the bone marrow, called soluble urokinase plasminogen activator receptor (suPAR,) is a strong risk factor for acute forms of kidney failure, that occur as consequence of general medical procedures, said Jochen Reiser, MD, PhD, a professor at Rush University Medical Center and chairperson of Rushs Department of Internal Medicine.

• #3

  https://www.kidney.org.uk/preventing-akis

  It is estimated that 65% of Acute Kidney Injuries start in the community (Selby 2012). This information aims to provide insight into what can cause an AKI, symptoms and prevention. […] An AKI can happen to anyone, but there are some people that have added risk factors for getting an AKI. […] These risk factors will mean that you could be more susceptible to getting an AKI but it can happen to anyone. AKI is usually caused by stress on the kidneys due to something happening in the body. […] There are several things you can do to help to prevent an AKI from occurring or getting worse. These are: – Ensure you are well hydrated aiming to drink 1.5-2 litres of water a day (unless you are on a fluid restriction which has been advised by a medical clinician) […] If you have had an AKI, ensure you have had repeat bloods to ensure your kidney function has improved.

• #4 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. […] General management principles for acute kidney injury include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function. […] Pharmacist-led quality-improvement programs reduce nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] Acute kidney injury care bundles are associated with improved in-hospital mortality rates and reduced risk of progression. […] Protocol-based strategies are recommended to prevent and improve acute kidney injury in high-risk patients (e.g., those who are postoperative or in septic shock).

• #5 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://www.medintensiva.org/en-prevention-acute-kidney-injury-in-articulo-S2173572717300395

  Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. […] In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. […] Prevention is the best method for avoiding AKI, with the early identification of the patients at risk and controlling the potentially modifiable risk factors, including the non-prescription or interruption of nephrotoxic drugs whenever possible. […] The early detection of the disease is the most important secondary prevention, allowing us to detect the disease at its earliest stage to be able to apply all the measures aimed at preventing its progression.

• #6 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Acute Kidney Injury (AKI) is common, expensive to manage, prolongs hospitalization and is associated with increased mortality. […] The NCEPOD report identified inadequate assessment of patients at risk of AKI and deemed 60% of post-admission AKI was predictable and 21% was avoidable. […] NICE have calculated that if AKI was recognized and treated with attention to hydration and medication, 100,000 cases could be prevented and up to 42,000 deaths avoided annually. […] The aim of this Grand Rounds article is to provide practical information on prevention and management of AKI. […] Patients in the community with CKD (eGFR 60 mL/ min/1.73m2) and patients with normal renal function who are treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) are at increased risk of AKI if they develop an illness associated with hypovolaemia and hypertension.

• #7 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Acute Kidney Injury (AKI) is common, expensive to manage, prolongs hospitalization and is associated with increased mortality. […] The NCEPOD report identified inadequate assessment of patients at risk of AKI and deemed 60% of post-admission AKI was predictable and 21% was avoidable. […] NICE have calculated that if AKI was recognized and treated with attention to hydration and medication, 100,000 cases could be prevented and up to 42,000 deaths avoided annually. […] The aim of this Grand Rounds article is to provide practical information on prevention and management of AKI. […] Patients in the community with CKD (eGFR 60 mL/ min/1.73m2) and patients with normal renal function who are treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) are at increased risk of AKI if they develop an illness associated with hypovolaemia and hypertension.

• #8 Practices for potential prevention and early recognition of acute kidney injury | bioMérieux Living Diagnostics Blog

  https://www.biomerieux.com/corp/en/blog/acute-care/Practices-potential-prevention-early-recognition-acute-kidney-injury.html

  Acute kidney injury (AKI), a sudden reduction in kidney function, is associated with a high rate of prolonged hospitalization, in-hospital mortality and increased expenses for hospitals. Many studies have found that AKI is widely preventable. […] While prevention can reduce the onset or severity of AKI, there are still challenges to overcome. […] Healthcare professionals should identify at-risk patients and implement preventive interventions. […] Another important method of prevention includes not only identifying those patients who are at an increased risk, but ensuring those patients have a care plan that includes for example a kidney health assessment every 12 months. […] Improvements and advancements with diagnostic tools, guidelines, standards, and analytical platforms have the potential to improve AKI related outcomes, but research must be prioritized to help develop and further optimize these tools. […] Additionally, according to the UK National Institute for Health and Care Excellence, with proper prevention practices in place, as many as 42,000 deaths each year could be avoided.

• #9 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://www.medintensiva.org/en-prevention-acute-kidney-injury-in-articulo-S2173572717300395

  Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. […] In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. […] Prevention is the best method for avoiding AKI, with the early identification of the patients at risk and controlling the potentially modifiable risk factors, including the non-prescription or interruption of nephrotoxic drugs whenever possible. […] The early detection of the disease is the most important secondary prevention, allowing us to detect the disease at its earliest stage to be able to apply all the measures aimed at preventing its progression.

• #10 Acute Kidney Injury: Prevention of AKI – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/nephrology-hypertension/acute-kidney-injury-prevention-of-aki/

  Prevention of AKI can best be accomplished by identifying those patients at high risk for AKI. […] The most important risk factor for AKI is chronic kidney disease. Therefore, assessing renal function and estimating the GFR is the first step in assessing the risk of AKI. […] Preventive strategies should be considered when an individual at high risk for AKI is undergoing a procedure or being exposed to a drug associated with risk of AKI. The first step would be to alter or consider alternatives to interventions or treatments that could potentially cause kidney injury. […] Optimization of renal blood flow and renal tissue perfusion is critical in preventing acute kidney injury, especially ischemic ATN. […] Intraoperative fluid management can affect outcomes following elective surgery. […] In septicemia, volume expansion combined with the use of vasopressor agents might be needed to optimize renal perfusion. […] Fluid management can be achieved with the use of crystalloids or colloid solutions. […] In contrast-induced AKI (CI-AKI) a number of studies have been performed to evaluate the effectiveness of interventions in the prevention of CI-AKI.

• #11 Acute Kidney Injury: Prevention of AKI – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/nephrology-hypertension/acute-kidney-injury-prevention-of-aki/

  Prevention of AKI can best be accomplished by identifying those patients at high risk for AKI. […] The most important risk factor for AKI is chronic kidney disease. Therefore, assessing renal function and estimating the GFR is the first step in assessing the risk of AKI. […] Preventive strategies should be considered when an individual at high risk for AKI is undergoing a procedure or being exposed to a drug associated with risk of AKI. The first step would be to alter or consider alternatives to interventions or treatments that could potentially cause kidney injury. […] Optimization of renal blood flow and renal tissue perfusion is critical in preventing acute kidney injury, especially ischemic ATN. […] Intraoperative fluid management can affect outcomes following elective surgery. […] In septicemia, volume expansion combined with the use of vasopressor agents might be needed to optimize renal perfusion. […] Fluid management can be achieved with the use of crystalloids or colloid solutions. […] In contrast-induced AKI (CI-AKI) a number of studies have been performed to evaluate the effectiveness of interventions in the prevention of CI-AKI.

• #12 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Acute Kidney Injury (AKI) is common, expensive to manage, prolongs hospitalization and is associated with increased mortality. […] The NCEPOD report identified inadequate assessment of patients at risk of AKI and deemed 60% of post-admission AKI was predictable and 21% was avoidable. […] NICE have calculated that if AKI was recognized and treated with attention to hydration and medication, 100,000 cases could be prevented and up to 42,000 deaths avoided annually. […] The aim of this Grand Rounds article is to provide practical information on prevention and management of AKI. […] Patients in the community with CKD (eGFR 60 mL/ min/1.73m2) and patients with normal renal function who are treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) are at increased risk of AKI if they develop an illness associated with hypovolaemia and hypertension.

• #13 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://medintensiva.org/es-prevention-acute-kidney-injury-in-articulo-S0210569117300037

  Numerous risk factors have been identified in the literature connected with the development of AKI, having an age of over 75 years, Diabetes Mellitus (DM) and the presence of chronic kidney disease (CKD) being the most notable. […] The most significant clinical factors include sepsis, hypovolemia, arterial hypotension, congestive heart failure, time of clamping in patients who undergo heart surgery, complex and prolonged surgery, a high severity index score at hospital admission and recent administration of nephrotoxic medication. […] Prevention is the best method for avoiding AKI, with the early identification of the patients at risk and controlling the potentially modifiable risk factors, including the non-prescription or interruption of nephrotoxic drugs whenever possible. […] The objective of hydration is to maintain enough intravascular volume in order to be able to increase renal perfusion, dilute the high concentrations of substances in the renal tubules, prevent prolonged contact, establish adequate diuresis prior to the administration of contrast and to prevent hypotension.

• #14 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://medintensiva.org/es-prevention-acute-kidney-injury-in-articulo-S0210569117300037

  Numerous risk factors have been identified in the literature connected with the development of AKI, having an age of over 75 years, Diabetes Mellitus (DM) and the presence of chronic kidney disease (CKD) being the most notable. […] The most significant clinical factors include sepsis, hypovolemia, arterial hypotension, congestive heart failure, time of clamping in patients who undergo heart surgery, complex and prolonged surgery, a high severity index score at hospital admission and recent administration of nephrotoxic medication. […] Prevention is the best method for avoiding AKI, with the early identification of the patients at risk and controlling the potentially modifiable risk factors, including the non-prescription or interruption of nephrotoxic drugs whenever possible. […] The objective of hydration is to maintain enough intravascular volume in order to be able to increase renal perfusion, dilute the high concentrations of substances in the renal tubules, prevent prolonged contact, establish adequate diuresis prior to the administration of contrast and to prevent hypotension.

• #15 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  This guideline covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury. […] Health professionals should follow our general guidelines for people delivering care: […] 1.2. Preventing acute kidney injury […] Follow the recommendations in the NICE guideline on acutely ill adults in hospital on the use of track and trigger systems (early warning scores) to identify adults who are at risk of acute kidney injury because their clinical condition is deteriorating or is at risk of deteriorating. […] When adults are at risk of acute kidney injury, ensure that systems are in place to recognise and respond to oliguria (urine output less than 0.5 ml/kg/hour) if the track and trigger system (early warning score) does not monitor urine output.

• #16 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  This guideline covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury. […] Health professionals should follow our general guidelines for people delivering care: […] 1.2. Preventing acute kidney injury […] Follow the recommendations in the NICE guideline on acutely ill adults in hospital on the use of track and trigger systems (early warning scores) to identify adults who are at risk of acute kidney injury because their clinical condition is deteriorating or is at risk of deteriorating. […] When adults are at risk of acute kidney injury, ensure that systems are in place to recognise and respond to oliguria (urine output less than 0.5 ml/kg/hour) if the track and trigger system (early warning score) does not monitor urine output.

• #17 Acute kidney injury: prevention and recognition | Nursing Times

  https://www.nursingtimes.net/emergency-and-critical-care/acute-kidney-injury-prevention-and-recognition-20-07-2015/

  NICE (2013) recommends that all patients in hospital should have their clinical observations scored regularly using an EWS system. This will aid the identification of those who are at risk of AKI because their clinical condition is deteriorating or is at risk of deteriorating. […] Nurses play a pivotal role in improving outcomes, especially by identifying risk factors and helping to prevent AKI.

• #18 Acute kidney injury: prevention and recognition | Nursing Times

  https://www.nursingtimes.net/emergency-and-critical-care/acute-kidney-injury-prevention-and-recognition-20-07-2015/

  NICE (2013) recommends that all patients in hospital should have their clinical observations scored regularly using an EWS system. This will aid the identification of those who are at risk of AKI because their clinical condition is deteriorating or is at risk of deteriorating. […] Nurses play a pivotal role in improving outcomes, especially by identifying risk factors and helping to prevent AKI.

• #19 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Prevention of AKI should follow the following principles; […] All patients, both on admission and during their hospital stay should be assessed regularly for their risk of developing AKI. […] Hypotension systolic blood pressure (SBP) 110 mmHg / mean arterial pressure (MAP) 65 mmHg) needs urgent assessment and treatment with IV fluid challenges and vasopressor agents where indicated. […] Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure 110 mmHg) and / or deteriorating renal function. […] AKI secondary to radiological contrast media typically occurs within 72 hrs of receiving such agents. The risk of contrast nephropathy can be reduced by temporary cessation of potentially nephrotoxic medication and adequate volume expansion.

• #20 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Prevention of AKI should follow the following principles; […] All patients, both on admission and during their hospital stay should be assessed regularly for their risk of developing AKI. […] Hypotension systolic blood pressure (SBP) 110 mmHg / mean arterial pressure (MAP) 65 mmHg) needs urgent assessment and treatment with IV fluid challenges and vasopressor agents where indicated. […] Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure 110 mmHg) and / or deteriorating renal function. […] AKI secondary to radiological contrast media typically occurs within 72 hrs of receiving such agents. The risk of contrast nephropathy can be reduced by temporary cessation of potentially nephrotoxic medication and adequate volume expansion.

• #21

  https://www.kidney.org.uk/preventing-akis

  It is estimated that 65% of Acute Kidney Injuries start in the community (Selby 2012). This information aims to provide insight into what can cause an AKI, symptoms and prevention. […] An AKI can happen to anyone, but there are some people that have added risk factors for getting an AKI. […] These risk factors will mean that you could be more susceptible to getting an AKI but it can happen to anyone. AKI is usually caused by stress on the kidneys due to something happening in the body. […] There are several things you can do to help to prevent an AKI from occurring or getting worse. These are: – Ensure you are well hydrated aiming to drink 1.5-2 litres of water a day (unless you are on a fluid restriction which has been advised by a medical clinician) […] If you have had an AKI, ensure you have had repeat bloods to ensure your kidney function has improved.

• #22 Acute Kidney Injury (AKI) – Genitourinary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Acute kidney injury (AKI) can often be prevented by maintaining normal fluid balance, blood volume, and blood pressure in patients with trauma, burns, or severe hemorrhage and in those undergoing major surgery. Infusion of isotonic saline and blood may be helpful. […] Use of iodinated contrast agents should be minimized, particularly in at-risk groups (eg, older patients and those with preexisting renal insufficiency, volume depletion, diabetes, or heart failure) for contrast nephropathy. If contrast agents are necessary, risk can be lowered by minimizing volume of the IV contrast agent, using nonionic and low osmolal or iso-osmolal contrast agents, avoiding nonsteroidal anti-inflammatory drugs, and pretreating with normal saline at 1 mL/kg/hour IV for 12 hours before the test. Infusion of isotonic sodium bicarbonate before and after contrast administration has also been used successfully instead of normal saline, especially in patients with concurrent metabolic acidosis.

• #23 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Prevention of AKI should follow the following principles; […] All patients, both on admission and during their hospital stay should be assessed regularly for their risk of developing AKI. […] Hypotension systolic blood pressure (SBP) 110 mmHg / mean arterial pressure (MAP) 65 mmHg) needs urgent assessment and treatment with IV fluid challenges and vasopressor agents where indicated. […] Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure 110 mmHg) and / or deteriorating renal function. […] AKI secondary to radiological contrast media typically occurs within 72 hrs of receiving such agents. The risk of contrast nephropathy can be reduced by temporary cessation of potentially nephrotoxic medication and adequate volume expansion.

• #24 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  As the majority of cases of AKI occur in association with volume depletion and sepsis, it is essential to restore effective renal perfusion as soon as possible. […] Maintenance of SBP according to pre-morbid values may play an important role in preventing kidney injury in hospitalised patients. […] Patients who develop AKI require revision of all prescribed medications. […] All medications that are metabolized and excreted by the kidneys should be dose adjusted for an assumed eGFR of 10 mL/min/1.73m2. […] The indication for dialysis is based on the complications of AKI rather than an absolute value for serum urea, creatinine or GFR. […] The Northern Ireland GAIN guidelines recommend referral of the following groups of patients.

• #25 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  This guideline covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury. […] Health professionals should follow our general guidelines for people delivering care: […] 1.2. Preventing acute kidney injury […] Follow the recommendations in the NICE guideline on acutely ill adults in hospital on the use of track and trigger systems (early warning scores) to identify adults who are at risk of acute kidney injury because their clinical condition is deteriorating or is at risk of deteriorating. […] When adults are at risk of acute kidney injury, ensure that systems are in place to recognise and respond to oliguria (urine output less than 0.5 ml/kg/hour) if the track and trigger system (early warning score) does not monitor urine output.

• #26 Acute kidney injury

  https://www.nhs.uk/conditions/acute-kidney-injury/

  Those at risk of AKI should be monitored with regular blood tests if they become unwell or start new medicine. […] It’s also useful to check how much pee you’re passing. […] Any warning signs of AKI, such as vomiting or producing little pee, require immediate investigation for AKI and treatment. […] People who are dehydrated or at risk of dehydration may need to be given fluids through a drip. […] Any medicine that seems to be making the problem worse or directly damaging the kidneys needs to be stopped, at least temporarily.

• #27 Acute Kidney Injury: Symptoms and Treatment

  https://patient.info/kidney-urinary-tract/acute-kidney-injury-leaflet

  Prevention is certainly better than cure for acute kidney injury. Patients in hospital should be tested for AKI regularly. This is done by frequent blood tests and measuring how much urine they produce (and weight for children). […] If you are having scans or X-rays with a dye (contrast) should be checked to see how likely they are to develop AKI. The doctor ordering the scan might request a blood test to check the kidneys before the scan – this is important to have as the scan might be cancelled without this. If you are at risk, and if the test is really necessary, the chances of AKI are lower if you have a drip with extra fluid first. Kidney blood tests should be regularly checked after the dye scan. […] Medicines which cause kidney damage should be avoided where it is possible. If they can’t be avoided, the lowest possible dose should be used and tests done regularly to keep a check on how the kidneys are coping.

• #28 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  As the majority of cases of AKI occur in association with volume depletion and sepsis, it is essential to restore effective renal perfusion as soon as possible. […] Maintenance of SBP according to pre-morbid values may play an important role in preventing kidney injury in hospitalised patients. […] Patients who develop AKI require revision of all prescribed medications. […] All medications that are metabolized and excreted by the kidneys should be dose adjusted for an assumed eGFR of 10 mL/min/1.73m2. […] The indication for dialysis is based on the complications of AKI rather than an absolute value for serum urea, creatinine or GFR. […] The Northern Ireland GAIN guidelines recommend referral of the following groups of patients.

• #29 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  A review of medications requiring discontinuation, dose adjustment, or monitoring is critical to the management of acute kidney injury. […] The implementation of pharmacist-led quality-improvement programs is associated with reductions in nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] An individualized approach to implementing preventive strategies is based on the presence of clinical situations that increase the risk of acute kidney injury, such as exposure to intravenous contrast media and being in the perioperative period. […] Use of periprocedural normal saline and minimizing the volume of contrast media reduce the risk of contrast media-induced acute kidney injury. […] A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast media-induced acute kidney injury when compared with low-dose statins or placebo. […] A Cochrane review of 72 studies (n = 4,378) found no convincing evidence that any pharmacologic intervention reduces the risk of acute kidney injury during the perioperative period.

• #30 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. […] General management principles for acute kidney injury include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function. […] Pharmacist-led quality-improvement programs reduce nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] Acute kidney injury care bundles are associated with improved in-hospital mortality rates and reduced risk of progression. […] Protocol-based strategies are recommended to prevent and improve acute kidney injury in high-risk patients (e.g., those who are postoperative or in septic shock).

• #31 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  A review of medications requiring discontinuation, dose adjustment, or monitoring is critical to the management of acute kidney injury. […] The implementation of pharmacist-led quality-improvement programs is associated with reductions in nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] An individualized approach to implementing preventive strategies is based on the presence of clinical situations that increase the risk of acute kidney injury, such as exposure to intravenous contrast media and being in the perioperative period. […] Use of periprocedural normal saline and minimizing the volume of contrast media reduce the risk of contrast media-induced acute kidney injury. […] A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast media-induced acute kidney injury when compared with low-dose statins or placebo. […] A Cochrane review of 72 studies (n = 4,378) found no convincing evidence that any pharmacologic intervention reduces the risk of acute kidney injury during the perioperative period.

• #32 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Seek advice from a pharmacist about optimising medicines and drug dosing in adults, children and young people with or at risk of acute kidney injury. […] Consider temporarily stopping ACE inhibitors and ARBs in adults, children and young people with diarrhoea, vomiting or sepsis until their clinical condition has improved and stabilised.

• #33 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Seek advice from a pharmacist about optimising medicines and drug dosing in adults, children and young people with or at risk of acute kidney injury. […] Consider temporarily stopping ACE inhibitors and ARBs in adults, children and young people with diarrhoea, vomiting or sepsis until their clinical condition has improved and stabilised.

• #34 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Prevention of AKI should follow the following principles; […] All patients, both on admission and during their hospital stay should be assessed regularly for their risk of developing AKI. […] Hypotension systolic blood pressure (SBP) 110 mmHg / mean arterial pressure (MAP) 65 mmHg) needs urgent assessment and treatment with IV fluid challenges and vasopressor agents where indicated. […] Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure 110 mmHg) and / or deteriorating renal function. […] AKI secondary to radiological contrast media typically occurs within 72 hrs of receiving such agents. The risk of contrast nephropathy can be reduced by temporary cessation of potentially nephrotoxic medication and adequate volume expansion.

• #35 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Encourage oral hydration before and after procedures using intravenous iodine-based contrast media in adults at increased risk of contrast-associated acute kidney injury. […] For inpatients having iodine-based contrast media, consider intravenous volume expansion with either isotonic sodium bicarbonate or 0.9% sodium chloride if they are at particularly high risk. […] Consider temporarily stopping ACE inhibitors and ARBs in adults having iodine-based contrast media if they have chronic kidney disease with an eGFR less than 30 ml/min/1.73 m2. […] Discuss the persons care with a nephrology team before offering iodine-based contrast media to adults on renal replacement therapy, including people with a renal transplant, but do not delay emergency imaging for this. […] Consider electronic clinical decision support systems (CDSS) to support clinical decision making and prescribing, but ensure they do not replace clinical judgement.

• #36 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Seek advice from a pharmacist about optimising medicines and drug dosing in adults, children and young people with or at risk of acute kidney injury. […] Consider temporarily stopping ACE inhibitors and ARBs in adults, children and young people with diarrhoea, vomiting or sepsis until their clinical condition has improved and stabilised.

• #37 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Encourage oral hydration before and after procedures using intravenous iodine-based contrast media in adults at increased risk of contrast-associated acute kidney injury. […] For inpatients having iodine-based contrast media, consider intravenous volume expansion with either isotonic sodium bicarbonate or 0.9% sodium chloride if they are at particularly high risk. […] Consider temporarily stopping ACE inhibitors and ARBs in adults having iodine-based contrast media if they have chronic kidney disease with an eGFR less than 30 ml/min/1.73 m2. […] Discuss the persons care with a nephrology team before offering iodine-based contrast media to adults on renal replacement therapy, including people with a renal transplant, but do not delay emergency imaging for this. […] Consider electronic clinical decision support systems (CDSS) to support clinical decision making and prescribing, but ensure they do not replace clinical judgement.

• #38 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  Prevention of AKI should follow the following principles; […] All patients, both on admission and during their hospital stay should be assessed regularly for their risk of developing AKI. […] Hypotension systolic blood pressure (SBP) 110 mmHg / mean arterial pressure (MAP) 65 mmHg) needs urgent assessment and treatment with IV fluid challenges and vasopressor agents where indicated. […] Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure 110 mmHg) and / or deteriorating renal function. […] AKI secondary to radiological contrast media typically occurs within 72 hrs of receiving such agents. The risk of contrast nephropathy can be reduced by temporary cessation of potentially nephrotoxic medication and adequate volume expansion.

• #39 Acute Kidney Injury (AKI) – Genitourinary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Acute kidney injury (AKI) can often be prevented by maintaining normal fluid balance, blood volume, and blood pressure in patients with trauma, burns, or severe hemorrhage and in those undergoing major surgery. Infusion of isotonic saline and blood may be helpful. […] Use of iodinated contrast agents should be minimized, particularly in at-risk groups (eg, older patients and those with preexisting renal insufficiency, volume depletion, diabetes, or heart failure) for contrast nephropathy. If contrast agents are necessary, risk can be lowered by minimizing volume of the IV contrast agent, using nonionic and low osmolal or iso-osmolal contrast agents, avoiding nonsteroidal anti-inflammatory drugs, and pretreating with normal saline at 1 mL/kg/hour IV for 12 hours before the test. Infusion of isotonic sodium bicarbonate before and after contrast administration has also been used successfully instead of normal saline, especially in patients with concurrent metabolic acidosis.

• #40 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://medintensiva.org/es-prevention-acute-kidney-injury-in-articulo-S0210569117300037

  To prevent CA-AKI different kinds of preventive therapies have been trialed. The most adequate approach seems to be to identify patients at risk, administer appropriate peri-procedural hydration and to minimize the quantity of contrast administered. […] The early detection of the disease is the most important secondary prevention, allowing us to detect the disease at its earliest stage to be able to apply all the measures aimed at preventing its progression.

• #41 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  A review of medications requiring discontinuation, dose adjustment, or monitoring is critical to the management of acute kidney injury. […] The implementation of pharmacist-led quality-improvement programs is associated with reductions in nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] An individualized approach to implementing preventive strategies is based on the presence of clinical situations that increase the risk of acute kidney injury, such as exposure to intravenous contrast media and being in the perioperative period. […] Use of periprocedural normal saline and minimizing the volume of contrast media reduce the risk of contrast media-induced acute kidney injury. […] A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast media-induced acute kidney injury when compared with low-dose statins or placebo. […] A Cochrane review of 72 studies (n = 4,378) found no convincing evidence that any pharmacologic intervention reduces the risk of acute kidney injury during the perioperative period.

• #42 Acute Kidney Injury (AKI) – Genitourinary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Acute kidney injury (AKI) can often be prevented by maintaining normal fluid balance, blood volume, and blood pressure in patients with trauma, burns, or severe hemorrhage and in those undergoing major surgery. Infusion of isotonic saline and blood may be helpful. […] Use of iodinated contrast agents should be minimized, particularly in at-risk groups (eg, older patients and those with preexisting renal insufficiency, volume depletion, diabetes, or heart failure) for contrast nephropathy. If contrast agents are necessary, risk can be lowered by minimizing volume of the IV contrast agent, using nonionic and low osmolal or iso-osmolal contrast agents, avoiding nonsteroidal anti-inflammatory drugs, and pretreating with normal saline at 1 mL/kg/hour IV for 12 hours before the test. Infusion of isotonic sodium bicarbonate before and after contrast administration has also been used successfully instead of normal saline, especially in patients with concurrent metabolic acidosis.

• #43 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Encourage oral hydration before and after procedures using intravenous iodine-based contrast media in adults at increased risk of contrast-associated acute kidney injury. […] For inpatients having iodine-based contrast media, consider intravenous volume expansion with either isotonic sodium bicarbonate or 0.9% sodium chloride if they are at particularly high risk. […] Consider temporarily stopping ACE inhibitors and ARBs in adults having iodine-based contrast media if they have chronic kidney disease with an eGFR less than 30 ml/min/1.73 m2. […] Discuss the persons care with a nephrology team before offering iodine-based contrast media to adults on renal replacement therapy, including people with a renal transplant, but do not delay emergency imaging for this. […] Consider electronic clinical decision support systems (CDSS) to support clinical decision making and prescribing, but ensure they do not replace clinical judgement.

• #44 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Encourage oral hydration before and after procedures using intravenous iodine-based contrast media in adults at increased risk of contrast-associated acute kidney injury. […] For inpatients having iodine-based contrast media, consider intravenous volume expansion with either isotonic sodium bicarbonate or 0.9% sodium chloride if they are at particularly high risk. […] Consider temporarily stopping ACE inhibitors and ARBs in adults having iodine-based contrast media if they have chronic kidney disease with an eGFR less than 30 ml/min/1.73 m2. […] Discuss the persons care with a nephrology team before offering iodine-based contrast media to adults on renal replacement therapy, including people with a renal transplant, but do not delay emergency imaging for this. […] Consider electronic clinical decision support systems (CDSS) to support clinical decision making and prescribing, but ensure they do not replace clinical judgement.

• #45 Acute Kidney Injury | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117660/all/Acute_Kidney_Injury

  Maintain adequate renal perfusion with isotonic fluids, vasopressor support if necessary. […] Avoid nephrotoxic agents. […] Effective strategies for AKI prevention: isotonic IVF, once-daily dosing of aminoglycosides; use of lipid formulations of amphotericin B, use of iso-osmolar nonionic contrast media. […] Risk of contrast-induced AKI is reduced by avoidance of hypovolemia: Inpatients: Isotonic saline 1 mL/kg/hr 612 hours preprocedure, during the procedure and 612 hours postprocedure. Outpatients: Isotonic saline 3 mL/kg/hr 1 hour preprocedure, 1 to 1.5 mL/kg/hour 46 hours during and after the procedure for a total of 6 ml/kg.

• #46 Acute Kidney Injury | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117660/all/Acute_Kidney_Injury

  Maintain adequate renal perfusion with isotonic fluids, vasopressor support if necessary. […] Avoid nephrotoxic agents. […] Effective strategies for AKI prevention: isotonic IVF, once-daily dosing of aminoglycosides; use of lipid formulations of amphotericin B, use of iso-osmolar nonionic contrast media. […] Risk of contrast-induced AKI is reduced by avoidance of hypovolemia: Inpatients: Isotonic saline 1 mL/kg/hr 612 hours preprocedure, during the procedure and 612 hours postprocedure. Outpatients: Isotonic saline 3 mL/kg/hr 1 hour preprocedure, 1 to 1.5 mL/kg/hour 46 hours during and after the procedure for a total of 6 ml/kg.

• #47 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  A review of medications requiring discontinuation, dose adjustment, or monitoring is critical to the management of acute kidney injury. […] The implementation of pharmacist-led quality-improvement programs is associated with reductions in nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] An individualized approach to implementing preventive strategies is based on the presence of clinical situations that increase the risk of acute kidney injury, such as exposure to intravenous contrast media and being in the perioperative period. […] Use of periprocedural normal saline and minimizing the volume of contrast media reduce the risk of contrast media-induced acute kidney injury. […] A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast media-induced acute kidney injury when compared with low-dose statins or placebo. […] A Cochrane review of 72 studies (n = 4,378) found no convincing evidence that any pharmacologic intervention reduces the risk of acute kidney injury during the perioperative period.

• #48 Acute kidney injury: prevention, detection and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552160/

  Encourage oral hydration before and after procedures using intravenous iodine-based contrast media in adults at increased risk of contrast-associated acute kidney injury. […] For inpatients having iodine-based contrast media, consider intravenous volume expansion with either isotonic sodium bicarbonate or 0.9% sodium chloride if they are at particularly high risk. […] Consider temporarily stopping ACE inhibitors and ARBs in adults having iodine-based contrast media if they have chronic kidney disease with an eGFR less than 30 ml/min/1.73 m2. […] Discuss the persons care with a nephrology team before offering iodine-based contrast media to adults on renal replacement therapy, including people with a renal transplant, but do not delay emergency imaging for this. […] Consider electronic clinical decision support systems (CDSS) to support clinical decision making and prescribing, but ensure they do not replace clinical judgement.

• #49 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  A review of medications requiring discontinuation, dose adjustment, or monitoring is critical to the management of acute kidney injury. […] The implementation of pharmacist-led quality-improvement programs is associated with reductions in nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] An individualized approach to implementing preventive strategies is based on the presence of clinical situations that increase the risk of acute kidney injury, such as exposure to intravenous contrast media and being in the perioperative period. […] Use of periprocedural normal saline and minimizing the volume of contrast media reduce the risk of contrast media-induced acute kidney injury. […] A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast media-induced acute kidney injury when compared with low-dose statins or placebo. […] A Cochrane review of 72 studies (n = 4,378) found no convincing evidence that any pharmacologic intervention reduces the risk of acute kidney injury during the perioperative period.

• #50 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. […] General management principles for acute kidney injury include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function. […] Pharmacist-led quality-improvement programs reduce nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] Acute kidney injury care bundles are associated with improved in-hospital mortality rates and reduced risk of progression. […] Protocol-based strategies are recommended to prevent and improve acute kidney injury in high-risk patients (e.g., those who are postoperative or in septic shock).

• #51 Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04640-1

  Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning. […] We found the use of GDP, RIPc and pulsatile blood flow during CPB associated with significantly reduced incidence of CSA-AKI. […] No intervention had high quality of evidence. Conversely, 2 interventions (restrictive transfusion strategy and tight glycemic control) had high quality of evidence for a lack of effect on reducing CSA-AKI incidence. […] In our meta-analysis, we identified 3 non-pharmacological interventions that could reduce CSA-AKI incidence: GDP and RIPc with moderate quality of evidence and pulsatile flow during CPB with very low quality of evidence. We also identified 2 interventions (restrictive transfusion strategy and tight glycemic control) with no benefit in reducing CSA-AKI incidence and with high quality of evidence.

• #52 Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04640-1

  Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning. […] We found the use of GDP, RIPc and pulsatile blood flow during CPB associated with significantly reduced incidence of CSA-AKI. […] No intervention had high quality of evidence. Conversely, 2 interventions (restrictive transfusion strategy and tight glycemic control) had high quality of evidence for a lack of effect on reducing CSA-AKI incidence. […] In our meta-analysis, we identified 3 non-pharmacological interventions that could reduce CSA-AKI incidence: GDP and RIPc with moderate quality of evidence and pulsatile flow during CPB with very low quality of evidence. We also identified 2 interventions (restrictive transfusion strategy and tight glycemic control) with no benefit in reducing CSA-AKI incidence and with high quality of evidence.

• #53 Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04640-1

  Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning. […] We found the use of GDP, RIPc and pulsatile blood flow during CPB associated with significantly reduced incidence of CSA-AKI. […] No intervention had high quality of evidence. Conversely, 2 interventions (restrictive transfusion strategy and tight glycemic control) had high quality of evidence for a lack of effect on reducing CSA-AKI incidence. […] In our meta-analysis, we identified 3 non-pharmacological interventions that could reduce CSA-AKI incidence: GDP and RIPc with moderate quality of evidence and pulsatile flow during CPB with very low quality of evidence. We also identified 2 interventions (restrictive transfusion strategy and tight glycemic control) with no benefit in reducing CSA-AKI incidence and with high quality of evidence.

• #54

  https://journals.lww.com/anesthesia-analgesia/fulltext/2021/08000/prevention_of_cardiac_surgery_associated_acute.2.aspx

  Prospective, single-center trials have shown that the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations in high-risk patients significantly reduced the development of acute kidney injury (AKI) after surgery. […] In this multicenter, multinational, randomized controlled trial, we examined the adherence to the KDIGO bundle consisting of optimization of volume status and hemodynamics, functional hemodynamic monitoring, avoidance of nephrotoxic drugs, and prevention of hyperglycemia in high-risk patients identified by the urinary biomarkers tissue inhibitor of metalloproteinases-2 [TIMP-2] and insulin growth factor-binding protein 7 [IGFBP7] after cardiac surgery. […] Implementation of a KDIGO-derived treatment bundle is feasible in a multinational setting. Furthermore, moderate to severe AKI was significantly reduced in the intervention group.

• #55 Prevention and Management of Acute Kidney Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4255835/

  As the majority of cases of AKI occur in association with volume depletion and sepsis, it is essential to restore effective renal perfusion as soon as possible. […] Maintenance of SBP according to pre-morbid values may play an important role in preventing kidney injury in hospitalised patients. […] Patients who develop AKI require revision of all prescribed medications. […] All medications that are metabolized and excreted by the kidneys should be dose adjusted for an assumed eGFR of 10 mL/min/1.73m2. […] The indication for dialysis is based on the complications of AKI rather than an absolute value for serum urea, creatinine or GFR. […] The Northern Ireland GAIN guidelines recommend referral of the following groups of patients.

• #56 Acute Kidney Injury: Prevention of AKI – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/nephrology-hypertension/acute-kidney-injury-prevention-of-aki/

  Prevention of AKI can best be accomplished by identifying those patients at high risk for AKI. […] The most important risk factor for AKI is chronic kidney disease. Therefore, assessing renal function and estimating the GFR is the first step in assessing the risk of AKI. […] Preventive strategies should be considered when an individual at high risk for AKI is undergoing a procedure or being exposed to a drug associated with risk of AKI. The first step would be to alter or consider alternatives to interventions or treatments that could potentially cause kidney injury. […] Optimization of renal blood flow and renal tissue perfusion is critical in preventing acute kidney injury, especially ischemic ATN. […] Intraoperative fluid management can affect outcomes following elective surgery. […] In septicemia, volume expansion combined with the use of vasopressor agents might be needed to optimize renal perfusion. […] Fluid management can be achieved with the use of crystalloids or colloid solutions. […] In contrast-induced AKI (CI-AKI) a number of studies have been performed to evaluate the effectiveness of interventions in the prevention of CI-AKI.

• #57 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://www.medintensiva.org/en-prevention-acute-kidney-injury-in-articulo-S2173572717300395

  Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. […] In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. […] Prevention is the best method for avoiding AKI, with the early identification of the patients at risk and controlling the potentially modifiable risk factors, including the non-prescription or interruption of nephrotoxic drugs whenever possible. […] The early detection of the disease is the most important secondary prevention, allowing us to detect the disease at its earliest stage to be able to apply all the measures aimed at preventing its progression.

• #58 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://medintensiva.org/es-prevention-acute-kidney-injury-in-articulo-S0210569117300037

  Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. […] In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. […] In patients with intrahospital AKI, the cause is usually multifactorial, with kidney hypoperfusion being the most common (fundamentally related to hypovolemia, heart failure and arterial hypotension), followed by the administration of nephrotoxic drugs and thirdly, contrast associated acute kidney injury (CA-AKI).

• #59 Acute Kidney Injury (AKI) – Genitourinary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Before cytolytic therapy is initiated in patients with certain neoplastic diseases (eg, lymphoma, leukemia), treatment with rasburicase or allopurinol should be considered along with increasing urine flow by increasing oral or IV fluids to reduce urate crystalluria. Making the urine more alkaline (by giving oral or IV sodium bicarbonate or acetazolamide) has been recommended by some but is controversial because it may also induce urinary calcium phosphate precipitation and crystalluria, which may worsen AKI.

• #60 Acute Kidney Injury (AKI) – Genitourinary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Before cytolytic therapy is initiated in patients with certain neoplastic diseases (eg, lymphoma, leukemia), treatment with rasburicase or allopurinol should be considered along with increasing urine flow by increasing oral or IV fluids to reduce urate crystalluria. Making the urine more alkaline (by giving oral or IV sodium bicarbonate or acetazolamide) has been recommended by some but is controversial because it may also induce urinary calcium phosphate precipitation and crystalluria, which may worsen AKI.

• #61 Acute Kidney (Renal) Failure: Symptoms, Causes, Treatment & Prevention

  https://www.webmd.com/a-to-z-guides/what-is-acute-kidney-failure

  You can reduce your risk of getting acute kidney failure by practicing some healthy habits. […] Be careful when taking over-the-counter (OTC) pain medications. Whether you are taking NSAIDs such as aspirin, ibuprofen, and naproxen or other types of OTC pain medications such as acetaminophen, it’s important to read and follow the recommended dosing instructions on the package. If you take too much of these medications, you could increase your chances of getting acute kidney failure. […] Follow your doctor’s advice. If you have a higher risk of getting acute kidney failure because of preexisting kidney disease or other conditions, make sure to follow your doctor’s advice for treating and managing your condition. […] Keep a healthy lifestyle. Exercise, eating right, and drinking little or no alcohol can go a long way in preventing acute kidney failure.

• #62 Acute kidney injury – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048

  Acute kidney injury can happen when: […] You might cut your risk of acute kidney injury by taking care of your kidneys. Try to: […] Work with your healthcare team to manage kidney and other ongoing conditions. Kidney disease, diabetes or high blood pressure increases your risk of acute kidney injury. If you have one of these, do what your healthcare team tells you to manage your condition. […] If you have risk factors for kidney disease, check with your healthcare team to be sure that prescription medicines you take are safe for your kidneys. […] Read labels when taking pain medicines available without a prescription. Do what the label says when taking medicines such as aspirin, acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Taking too much of these medicines may increase your risk of kidney injury. This is especially true if you already have kidney disease, diabetes or high blood pressure. […] Live a healthy lifestyle. Be active and eat a healthy, balanced diet. If you drink alcohol, drink only in moderation.

• #63 Acute kidney injury – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048

  Acute kidney injury can happen when: […] You might cut your risk of acute kidney injury by taking care of your kidneys. Try to: […] Work with your healthcare team to manage kidney and other ongoing conditions. Kidney disease, diabetes or high blood pressure increases your risk of acute kidney injury. If you have one of these, do what your healthcare team tells you to manage your condition. […] If you have risk factors for kidney disease, check with your healthcare team to be sure that prescription medicines you take are safe for your kidneys. […] Read labels when taking pain medicines available without a prescription. Do what the label says when taking medicines such as aspirin, acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Taking too much of these medicines may increase your risk of kidney injury. This is especially true if you already have kidney disease, diabetes or high blood pressure. […] Live a healthy lifestyle. Be active and eat a healthy, balanced diet. If you drink alcohol, drink only in moderation.

• #64 Acute Kidney (Renal) Failure: Symptoms, Causes, Treatment & Prevention

  https://www.webmd.com/a-to-z-guides/what-is-acute-kidney-failure

  You can reduce your risk of getting acute kidney failure by practicing some healthy habits. […] Be careful when taking over-the-counter (OTC) pain medications. Whether you are taking NSAIDs such as aspirin, ibuprofen, and naproxen or other types of OTC pain medications such as acetaminophen, it’s important to read and follow the recommended dosing instructions on the package. If you take too much of these medications, you could increase your chances of getting acute kidney failure. […] Follow your doctor’s advice. If you have a higher risk of getting acute kidney failure because of preexisting kidney disease or other conditions, make sure to follow your doctor’s advice for treating and managing your condition. […] Keep a healthy lifestyle. Exercise, eating right, and drinking little or no alcohol can go a long way in preventing acute kidney failure.

• #65 Acute kidney injury – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048

  Acute kidney injury can happen when: […] You might cut your risk of acute kidney injury by taking care of your kidneys. Try to: […] Work with your healthcare team to manage kidney and other ongoing conditions. Kidney disease, diabetes or high blood pressure increases your risk of acute kidney injury. If you have one of these, do what your healthcare team tells you to manage your condition. […] If you have risk factors for kidney disease, check with your healthcare team to be sure that prescription medicines you take are safe for your kidneys. […] Read labels when taking pain medicines available without a prescription. Do what the label says when taking medicines such as aspirin, acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Taking too much of these medicines may increase your risk of kidney injury. This is especially true if you already have kidney disease, diabetes or high blood pressure. […] Live a healthy lifestyle. Be active and eat a healthy, balanced diet. If you drink alcohol, drink only in moderation.

• #66 Acute Kidney (Renal) Failure: Symptoms, Causes, Treatment & Prevention

  https://www.webmd.com/a-to-z-guides/what-is-acute-kidney-failure

  You can reduce your risk of getting acute kidney failure by practicing some healthy habits. […] Be careful when taking over-the-counter (OTC) pain medications. Whether you are taking NSAIDs such as aspirin, ibuprofen, and naproxen or other types of OTC pain medications such as acetaminophen, it’s important to read and follow the recommended dosing instructions on the package. If you take too much of these medications, you could increase your chances of getting acute kidney failure. […] Follow your doctor’s advice. If you have a higher risk of getting acute kidney failure because of preexisting kidney disease or other conditions, make sure to follow your doctor’s advice for treating and managing your condition. […] Keep a healthy lifestyle. Exercise, eating right, and drinking little or no alcohol can go a long way in preventing acute kidney failure.

• #67 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://www.medintensiva.org/en-prevention-acute-kidney-injury-in-articulo-S2173572717300395

  Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. […] In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. […] Prevention is the best method for avoiding AKI, with the early identification of the patients at risk and controlling the potentially modifiable risk factors, including the non-prescription or interruption of nephrotoxic drugs whenever possible. […] The early detection of the disease is the most important secondary prevention, allowing us to detect the disease at its earliest stage to be able to apply all the measures aimed at preventing its progression.

• #68 Prevention of acute kidney injury in Intensive Care Units | Medicina Intensiva

  https://medintensiva.org/es-prevention-acute-kidney-injury-in-articulo-S0210569117300037

  To prevent CA-AKI different kinds of preventive therapies have been trialed. The most adequate approach seems to be to identify patients at risk, administer appropriate peri-procedural hydration and to minimize the quantity of contrast administered. […] The early detection of the disease is the most important secondary prevention, allowing us to detect the disease at its earliest stage to be able to apply all the measures aimed at preventing its progression.

• #69 Acute kidney injury

  https://www.nhs.uk/conditions/acute-kidney-injury/

  Those at risk of AKI should be monitored with regular blood tests if they become unwell or start new medicine. […] It’s also useful to check how much pee you’re passing. […] Any warning signs of AKI, such as vomiting or producing little pee, require immediate investigation for AKI and treatment. […] People who are dehydrated or at risk of dehydration may need to be given fluids through a drip. […] Any medicine that seems to be making the problem worse or directly damaging the kidneys needs to be stopped, at least temporarily.

• #70 Acute kidney injury

  https://www.nhs.uk/conditions/acute-kidney-injury/

  Those at risk of AKI should be monitored with regular blood tests if they become unwell or start new medicine. […] It’s also useful to check how much pee you’re passing. […] Any warning signs of AKI, such as vomiting or producing little pee, require immediate investigation for AKI and treatment. […] People who are dehydrated or at risk of dehydration may need to be given fluids through a drip. […] Any medicine that seems to be making the problem worse or directly damaging the kidneys needs to be stopped, at least temporarily.

• #71 Acute kidney injury

  https://www.nhs.uk/conditions/acute-kidney-injury/

  Those at risk of AKI should be monitored with regular blood tests if they become unwell or start new medicine. […] It’s also useful to check how much pee you’re passing. […] Any warning signs of AKI, such as vomiting or producing little pee, require immediate investigation for AKI and treatment. […] People who are dehydrated or at risk of dehydration may need to be given fluids through a drip. […] Any medicine that seems to be making the problem worse or directly damaging the kidneys needs to be stopped, at least temporarily.

• #72 Acute kidney injury

  https://www.nhs.uk/conditions/acute-kidney-injury/

  Those at risk of AKI should be monitored with regular blood tests if they become unwell or start new medicine. […] It’s also useful to check how much pee you’re passing. […] Any warning signs of AKI, such as vomiting or producing little pee, require immediate investigation for AKI and treatment. […] People who are dehydrated or at risk of dehydration may need to be given fluids through a drip. […] Any medicine that seems to be making the problem worse or directly damaging the kidneys needs to be stopped, at least temporarily.

• #73

  https://www.kidney.org.uk/preventing-akis

  It is estimated that 65% of Acute Kidney Injuries start in the community (Selby 2012). This information aims to provide insight into what can cause an AKI, symptoms and prevention. […] An AKI can happen to anyone, but there are some people that have added risk factors for getting an AKI. […] These risk factors will mean that you could be more susceptible to getting an AKI but it can happen to anyone. AKI is usually caused by stress on the kidneys due to something happening in the body. […] There are several things you can do to help to prevent an AKI from occurring or getting worse. These are: – Ensure you are well hydrated aiming to drink 1.5-2 litres of water a day (unless you are on a fluid restriction which has been advised by a medical clinician) […] If you have had an AKI, ensure you have had repeat bloods to ensure your kidney function has improved.

• #74 Researchers Reveal Target in Acute Kidney Injury Prevention | Rush

  https://www.rush.edu/news/researchers-reveal-target-acute-kidney-injury-prevention

  Up to 10% of patients who are hospitalized or undergo surgery will experience acute kidney injury (AKI), and as many as 50% of patients in intensive care units will meet the criteria for AKI, the National Kidney Foundation has determined. […] Researchers at Rush University Medical Center, in collaboration with colleagues at other institutions, have revealed a new treatment target that may help change the outcome for patients at risk of AKI. […] In this study, we found evidence that a specific protein produced by immune cells in the bone marrow, called soluble urokinase plasminogen activator receptor (suPAR,) is a strong risk factor for acute forms of kidney failure, that occur as consequence of general medical procedures, said Jochen Reiser, MD, PhD, a professor at Rush University Medical Center and chairperson of Rushs Department of Internal Medicine.

• #75 Researchers Reveal Target in Acute Kidney Injury Prevention | Rush

  https://www.rush.edu/news/researchers-reveal-target-acute-kidney-injury-prevention

  suPAR has been repeatedly shown to harm kidneys. […] Any kidney disease, chronic or acute, genetic or acquired, is better off with a lower suPAR level. By looking at suPAR levels in patients, we can possibly prevent damage to healthy kidneys that is often irreversible. […] Reiser believes that high suPAR levels will inform physician-patient conversations about preventing kidney disease, just as high cholesterol levels signal the need for lifestyle changes and protective drugs, such as statins, to avert heart attacks and strokes. […] Here we show that suPAR is relevant in important clinical situations such as coronary angiography and cardiac surgery, and could be targeted to minimize the risk of AKI, said Salim Hayek, MD, a cardiologist at the Michigan Medicine Frankel Cardiovascular Center and first author of the study.

• #76 Researchers Reveal Target in Acute Kidney Injury Prevention | Rush

  https://www.rush.edu/news/researchers-reveal-target-acute-kidney-injury-prevention

  The team found that suPAR levels independently predicted risk of AKI in each of these clinical settings. […] High SuPAR levels consistently predicted AKI in these patients, with levels above 3,000 picograms per milliliter doubling the risk of AKI. […] We are studying interventions to alter suPAR levels, said Reiser. […] We found that when mice were pretreated with a monoclonal antibody to block suPAR, the researchers managed to reduce the development and the severity of kidney injury.

• #77 Researchers Reveal Target in Acute Kidney Injury Prevention | Rush

  https://www.rush.edu/news/researchers-reveal-target-acute-kidney-injury-prevention

  The team found that suPAR levels independently predicted risk of AKI in each of these clinical settings. […] High SuPAR levels consistently predicted AKI in these patients, with levels above 3,000 picograms per milliliter doubling the risk of AKI. […] We are studying interventions to alter suPAR levels, said Reiser. […] We found that when mice were pretreated with a monoclonal antibody to block suPAR, the researchers managed to reduce the development and the severity of kidney injury.

• #78 Acute Kidney Injury (AKI) prevention with SUL-138 compound

  https://www.sulfateqbv.com/applications/drug-development/prevention-acute-kidney-injury/

  Currently there is no therapy or drugs available for the protection against AKI during major surgery. […] The incidence of AKI is approx. 1.5 million patients a year worldwide. […] In the USA alone, hospital-acquired AKI accounts for approx. 9 billion USD in medical costs annually. […] The background of developing the SUL-138 is the natural process of hibernation. […] Thus far, SUL-138 has proven to increase mitochondrial respiration during stress, thereby allowing for faster recovery of ATP. […] Translated into clinical practice, the main benefits of SUL-138 for Acute Kidney Injury prevention are: Improve survival rate of major surgery, Reduce days spent in ICU days spent in hospital, Prevention of the need for renal replacement therapies (e.g. dialysis).

• #79

  https://www.ncbi.ncbi.grantome.com/grant/NIH/R01-DK102691-04

  Acute kidney injury (AKI) in the face of chronic kidney disease is a frequent clinical problem with an increasing incidence, an unacceptably high mortality rate that has not improved in more than 50 years, and no specific treatment. […] Furthermore, novel therapeutic strategies are needed to meet the medical need for both safe and effective preventative and post-injury applications in AKI. […] We will design and deploy new nanoparticle therapeutic agents that are active against selected inflammatory signaling pathways in unique and effective formulations that provide localized sustained release of agents that may be synergistic in early and advanced AKI, and whose effects on kidney cells can be mapped over time with safe, noninvasive imaging tools. […] AIM 1. Deploy selected and synergistic nanoparticle agents singly and in combination against promising molecular targets in AKI (NFkB, thrombin, Bak/Bax) and define efficacy for early and late AKI, and as preventive agents in a mouse model of renal ischemia/reperfusion (I/R) injury.

• #80 Patient preferences and priorities for the design of an acute kidney injury prevention trial: Findings from a consensus workshop | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.03.04.24303721v2

  High-quality clinical trials are needed to establish the safety, efficacy, and real-world use of potential therapies for acute kidney injury (AKI) prevention. […] Findings from our workshop will directly inform development of a clinical trial protocol of cilastatin for nephrotoxic AKI prevention and can assist others in patient-centered approaches to AKI trial design.

• #81 The Role of Dexmedetomidine for the Prevention of Acute Kidney Injury in Critical Care – European Medical Journal

  https://www.emjreviews.com/nephrology/article/the-role-of-dexmedetomidine-for-the-prevention-of-acute-kidney-injury-in-critical-care-j120121/

  Acute kidney injury (AKI) occurs in up to 50% of patients admitted to the intensive care unit and is associated with increased mortality. […] Currently, there is no effective pharmacotherapy for prevention or treatment of AKI. […] Prevention bundles emphasise risk stratification and avoidance of hypotension, hypoperfusion, and refrainment from nephrotoxic substances. […] Clinical and animal studies point towards a protective effect of DEX against AKI in this setting. […] A meta-analysis and trial sequential analysis of nine randomised controlled trials (RCTs) with a total of 1,308 patients found robust evidence that DEX significantly reduced the incidence of AKI after cardiac surgery (risk ratio: 0.60; 95% confidence interval: 0.410.87; p=0.008). […] The protective effect on AKI was most evident when DEX was administered pre- or intraoperatively and in patients aged over 60 years.

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