Acute kidney injury (AKI) is a serious problem. Understanding an individual patient's risk profile may offer opportunities for prevention or early intervention. The aim of this review is to describe novel nontraditional risk factors.
The risk of AKI is determined by patient factors and nephrotoxic exposures. Hyperuricaemia, obesity, hypoalbuminaemia and certain genetic polymorphism have been found to be associated with an increased susceptibility to AKI, especially in surgical patients. However, there is no convincing evidence that albumin replacement or uric acid lowering ameliorates the risk. Genetic predisposition contributes to AKI in general and also drug-nephrotoxicity. The exact relationship between obesity and AKI has not been fully understood.
Patients exposed to starches, chloride-rich fluids or mechanical ventilation have an increased risk of AKI. Starches in particular should be avoided in high-risk patients. Although chloride-rich fluids are associated with AKI based on observational studies, direct proof of harm is lacking.
Novel risk factors for AKI have been identified but more work is necessary to investigate the nature of the association. There is no evidence that correction of hyperuricaemia or hypoalbuminaemia is beneficial but high-risk exposures should be avoided in patients at risk of AKI.
Departments of Critical Care and Nephrology, King's College London, Guy's and St Thomas’ Foundation Hospital London, UK
Correspondence to Marlies Ostermann, PhD, MD, FRCP, Department of Critical Care Medicine, Consultant in Critical Care and Nephrology, King's College London, Guy's and St Thomas’ Foundation Hospital, London SE1 7EH, U K. Tel: +44 207 1883038; fax: +44 207 1882284; e-mail: Marlies.Ostermann@gstt.nhs.uk