Acute Kidney Injury Management in the ICU

General Measures

• The American Journal of Kidney Diseases and Kidney International recommend determining the cause of acute kidney injury (AKI) and evaluating the patient quickly to identify reversible causes 1, 2
• The Kidney International suggests managing the patient according to the stage and cause of AKI, with special attention to reversible causes 2
• The Kidney International recommends monitoring hemodynamic and oxygenation parameters using protocol-based objectives to prevent the development or worsening of AKI in high-risk patients 2

Hemodynamic Management

• The American Journal of Kidney Diseases and Kidney International recommend using isotonic crystalloids instead of colloids (albumin or starches) as initial management for intravascular volume expansion in patients at risk of AKI or with established AKI 1, 2, 3
• The American Journal of Kidney Diseases recommends avoiding starch-containing solutions, as they have been associated with a higher incidence of AKI 4
• The Kidney International suggests using vasopressors along with fluids in patients with vasodilatory shock with AKI or at risk of developing it 2

Pharmacological Management

• The American Journal of Kidney Diseases and Nature Reviews Nephrology recommend avoiding or suspending nephrotoxic medications whenever possible 1, 5
• The Nature Reviews Nephrology suggests performing a systematic evaluation of the medication regimen, considering changes in drug clearance and alterations in pharmacokinetic parameters due to decreased renal function 5
• The American Journal of Kidney Diseases recommends not using low-dose dopamine to prevent or treat AKI 1, 4
• The American Journal of Kidney Diseases recommends not using diuretics to prevent AKI, but considering them only for managing volume overload 1

Nutritional Support

• The American Journal of Kidney Diseases and Kidney International recommend providing a total energy intake of 20-30 kcal/kg/day in patients with any stage of AKI 1, 2
• The Kidney International recommends not restricting protein intake to prevent or delay the initiation of renal replacement therapy 2
• The American Journal of Kidney Diseases and Kidney International recommend administering 0.8-1.0 g/kg/day of protein in patients with non-catabolic AKI without the need for dialysis 1, 2

Metabolic Control

• The American Journal of Kidney Diseases and Kidney International recommend maintaining blood glucose levels between 110-149 mg/dL (6.1-8.3 mmol/L) in critically ill patients 1, 2

Renal Replacement Therapy (RRT)

• The Kidney International recommends considering RRT when there is refractory volume overload, severe electrolyte disturbances, or severe metabolic acidosis 6
• The Kidney International recommends using continuous RRT as the most appropriate modality for patients with hemodynamic instability 6

Post-Discharge Follow-up

• The American Journal of Kidney Diseases recommends performing clinical follow-up after AKI, especially in patients with risk factors for progression to chronic kidney disease or end-stage renal disease 4
• The American Journal of Kidney Diseases recommends prioritizing early follow-up for patients with severe AKI (stage 3) and those with persistent renal dysfunction at hospital discharge 7, 8