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Interventions for improving outcomes in acute kidney injury

Sarnowski, Alexandera; Doyle, James F.b; Forni, Lui G.a,c

Current Opinion in Nephrology and Hypertension: November 2019 - Volume 28 - Issue 6 - p 567–572
doi: 10.1097/MNH.0000000000000552
DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal
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Purpose of review Since the adoption of the classification of acute kidney injury (AKI) through changes in serum creatinine and/or urine output, much data have accumulated as to the associated risks in terms of morbidity and mortality after the development of AKI. However, until recently, a nihilistic approach persisted which implied that little could be done to alter the clinical course of a patient with AKI even where early identification was achieved. This view is reinforced by the opinion that given the broad cause underlying the syndrome of AKI, a ‘one size fits all’ approach is unlikely to be successful.

Recent findings Recent evidence suggests that the management of AKI may be improved somewhat by simple measures, such as the use of care bundles particularly in the intensive care setting. Moreover, there are other interventions using common treatments, which may prove to be of benefit as well as some early evidence that specific therapeutics may be on the horizon.

Summary Although a syndrome of significantly differing causes, the application of standardized care bundles appears promising and this approach may be improved by the use of specific therapies, including recombinant alkaline phosphatase, the use of intravenous bicarbonate and remote ischaemic preconditioning may also ameliorate the effects of AKI.

aDepartment of Intensive Care Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford

bCritical Care Unit, Royal Brompton Hospital, London

cDepartment of Clinical and Experimental Medicine, School of Biosciences and Medicine University of Surrey, Guildford, UK

Correspondence to Lui G. Forni, Department of Intensive Care Medicine, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK. Tel: +44 1483 571122; xt 4057; e-mail: luiforni@nhs.net

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