KDIGO Clinical Practice Guidelines for Acute Kidney Injury

Furthermore, KDIGO suggests that AKI should be staged according to severity as outlined in table 2. The rationale for the staging system comes ... × Title (Title) Mr Ms Dr. Professor FirstName* LastName* Company/Institution E-Mail* Message *indicatesrequiredfields ThissiteisprotectedbyreCAPTCHAandtheGooglePrivacyPolicyandTermsofServiceapply. 0 0 × OurServices OurContent PublishWithUs AboutUs Login 0 0 JournalMenu JournalHome Contents:allyears × NephronClinicalPractice DownloadFulltextPDF ClinicalGuidelines FreeAccess KDIGOClinicalPracticeGuidelinesforAcuteKidneyInjury KhwajaA. Authoraffiliations SheffieldKidneyInstitute,NorthernGeneralHospital,Sheffield,UK CorrespondingAuthor Dr.ArifKhwaja,PhD,FRCPSheffieldKidneyInstitute,NorthernGeneralHospitalHerriesRoadSheffieldS57AU(UK)Tel.+441142714808,[email protected] RelatedArticlesfor"" NephronClinPract2012;120:c179–c184 https://doi.org/10.1159/000339789 Abstract FullText PDF References Extras:3 IntroductionAcutekidneyinjury(AKI)isanincreasinglycommonclinicalproblemfacedbynephrologistsandintensivists,aswellasgeneralphysiciansandsurgeons.AKIisassociatedwithadverseoutcomesbothintheshortandlongtermwithchronickidneydisease(CKD)beingincreasinglyrecognisedasacommonsequelaofAKI.Inananalysisof19,982consecutiveadmissionsinasinglecentreinBoston,USA,AKIwassignificantlyassociatedwithmortality,lengthofstayandhealthcarecost[1].Elevationsinserumcreatininewerecommon,affectingupto13%ofpatients,andevenrelativelymodestelevationsinserumcreatininewereassociatedadverseoutcomes–ariseinserumcreatinineof≥0.5mg/dl(44µmol/l)wasassociatedwith6.5-foldincreaseintheriskofdeath.TheinadequaciesofAKImanagementwerehighlightedbyarecentUKgovernmentsurveywherethecareofAKIwasdeemedinadequatein33%ofcases,withpoorrecognitionofriskfactorssuchassepsisandhypovolaemia[2].ThepatternandburdenofAKIappearstobeparticularlysignificantindevelopingcountries[3]andthereforetherecentlypublishedKidneyDiseaseImprovingGlobalGuidelines(KDIGO)ClinicalPracticeGuidelinesforAcuteKidneyInjuryprovidesawelcomeandtimelysynthesisoftheevidencebasetosupportthemanagementofAKI[4].Asinpreviousguidelines,KDIGOutilisedagradingsystemwithlevel1beingrateda‘strongrecommendation’,implyingthatmostpatients‘should’receiveaparticularaction.Incontrast,level2guidelinesareessentially‘suggestions’andaredeemedtobe‘weak’ordiscretionary,recognisingthatmanagementdecisionsmayvaryindifferentclinicalcontexts.EachrecommendationwasfurthergradedfromAtoDbythequalityofevidenceunderpinningthem,withgradeAreferringtoahighqualityofevidencewhilstgradeDrecogniseda‘verylow’evidencebase.Theoverallstrengthandqualityofthesupportingevidenceissummarisedintable1.Table 1SummaryofevidencelevelandstrengthofKDIGOrecommendationsTheguidelinesfocusedon4keydomains:(1)AKIdefinition,(2)preventionandtreatmentofAKI,(3)contrast-inducedAKI(CI-AKI)and(4)dialysisinterventionsforthetreatmentofAKI.Thefullsummaryofclinicalpracticestatementsisavailableatwww.kdigo.org,butafewkeyrecommendationstatementswillbehighlightedhere.AKIDefinitionAkeyrecommendationisthatclinicianseffectivelyadoptthepreviouslypublishedAKINetworkdefinitionofAKI[5]asoneofthefollowing:•Anincreaseinserumcreatinineby≥0.3mg/dl(≥26.5µmol/l)within48h•Anincreaseinserumcreatinineto≥1.5timesbaselinewithintheprevious7days•Urinevolume≤0.5ml/kg/hfor6hFurthermore,KDIGOsuggeststhatAKIshouldbestagedaccordingtoseverityasoutlinedintable2.Therationaleforthestagingsystemcomesfromaplethoraofstudiesshowingthattheriskofdeathandrenalreplacementtherapy(RRT)increaseswitheachstage[6,7,8].Furthermore,evidencesuggestingpatientsinwhomAKIresolvesareatincreasedriskofdeath,CKDandcardiovasculardisease[9,10]haspromptedKDIGOtomakeanungradedsuggestionthatallthosewithresolvedAKIshouldbeconsideredtobeatincreasedriskofCKDandbemanagedaspertheKDOQIguidelinesforindividualsatriskofCKD.OtherrecommendationsincludestratifyingpatientsforriskofAKIandmonitoringserumcreatinineaturineoutputinthoseatriskaswellasthosewithestablishedAKI.Table 2ProposedKDIGOstagingofAKIThelimitationsofanyclassificationsystembasedonserumcreatinineinpatientswhoarelikelytobecatabolicandnotinsteadystatearerecognisedbytheguidelines.Furthermore,theeffectsofageandpre-existingsarcopeniaontheaccuracyoftheclassificationsystemarenotclearlydiscussed,buttheyarelikelytoimpactontheaccuracyofanycreatinine-basedclassificationsystem.ClearlyknowingthebaselineserumcreatinineisessentialinutilisingtheclassificationsystemasAKIoftenbeginsbeforepatientsareadmittedtohospital,andformanypatientsthereisnorecordofbaselinekidneyfunction.Controversially,theguidelinessuggestthatpatientsshouldbeassumedtohaveabaselineeGFRof75ml/min/1.73m2incaseswherethereisnohistoryofCKDandbaselinekidneyfunctionisunknown.AlthoughthisapproachhasbeenvalidatedinAKIepidemiologystudiesinclinicalsettings,manycliniciansmaybereluctanttomakesuchassumptionsandthereisaninherentriskthatmanypatientswouldbeinappropriatelylabeledashavingAKIwithoutanyoutcomedatatoshowthatsuchlabelingwillimprovepatientoutcomes.Similarly,theuseofurineoutputasadiagnosticcriterionislesswellestablished.However,untiltheuseofbiomarkerssuchasN-GalandKim-1canbeconclusivelyshowntoimprovepatientoutcomesinAKI(ratherthanfacilitateearlierdiagnosis),theclinicalrealityisthatserumcreatininecombinedwithurineoutputwillremainthecornerstonefordiagnosingAKI.ThereisnodoubtthatstandardisingthedefinitionandstagingofAKIprovidesaclearframeworkforstudyingoutcomesinbothepidemiologicalandclinicalresearch.However,thedefinitionandstagingofAKIisungraded–reflectingthefactthatitcannotbesubjectedtosystemicreview.TheKDIGOworkgrouparguedthatungradedstatements‘shouldnotbeviewedasweakerthangradedrecommendations’.However,thebedsideutilityoftheproposedclassificationandstagingmaybequestionedbymany‘realworld’practicingclinicianswhowouldviewsuchstatementsasbeingopinion-basedratherthanevidence-based.Inparticular,itisnotclearhowstagingwillalterimmediatemanagementandoutcomes.Furthermore,whilstarecommendationismadetotreatthosewithresolvedAKIasbeingatincreasedriskofCKD,nospecificguidanceisgivenonthenatureorfrequencyofsuchmonitoring,noristhereanydatatoshowthecost-effectivenessofsuchastrategy.PreventionandTreatmentofAKIAtotalof25practicestatementsaremadeinthissection,manyofwhichseememinentlysensible,suchasthe‘useofvasopressorsinconjunctionwithfluidsinpatientswithvasomotorshock’(level1C).Importantly,theguidelinescriticallyreviewtheevidenceforanumberofagentswhichhavebeenevaluatedinthepreventionandtreatmentofAKI,allofwhichhavefailedtoshowanyconsistentbenefitincludingdopamine(level1A),fenoldopam(apuredopaminetype-1receptoragonistwithoutα-andβ-adrenergicstimulation;level2C),atrialnatriureticpeptide(level2C),insulin-likegrowthfactor-1(level1B)anddiuretics(level1B).ThereisnoroleforanyoftheseagentsinthemanagementofAKIthoughtheguidelinesacknowledgethatdiureticsmaybeusefulinthemanagementofvolumeoverload.Anumberofotherrecommendationsaremadeincluding:•Theuseofisotoniccrystalloidsratherthancolloidsforvolumeexpansion(level2B),basedonrandomisedcontrolledtrialssuchasSalineversusAlbuminFluidEvaluationcomparingalbuminwithisotonicsalineinanintensivecaresetting,whichfoundnodifferenceinoutcomes[11].Furthermore,arecentmeta-analysisshowedcertainpreparationsofcolloidssuchashyperoncoticstarchareactuallyassociatedwithAKI[12].•Insulintherapytotargetplasmaglucoseof110–149mg/dl(6.1–8.3mmol/l;level2C).Thismaybeasomewhatcontroversialrecommendationasthesethresholdshavenotbeenexaminedinarandomisedcontrolledtrialandtherisksofhypoglycaemiaaresignificantwithameta-analysisofintensiveinsulintherapytrialsshowinganincreasedriskofdeathinthosewithhypoglycaemia[13].•Avoidingaminoglycosides(level2A)ifpossibleandusingsingle-dailydosing(level2B)withtherapeuticdrugmonitoring(level1A).•Usingliposomalamphotericinorazolesand/orechinocandinsforfungalandparasiticinfections(level2A).•AvoidingtheuseoforalorintravenousN-acetylcysteine(NAC)forthepreventionofpostsurgicalAKI(level1A).Contrast-InducedAcuteKidneyInjuryTheincidenceofCI-AKIhasbeenreportedtobearound10.5%[14],withmortalityashighas35%inthosewhorequiredialysis[15].Clearlyitisdifficulttoteaseouttheroleofconfoundingvariables,buttheCI-AKIremainsapressingclinicalproblem.AnumberofrecommendationsaremadebyKDIGOincluding:•AssessriskforCI-AKIandscreenforkidneydiseaseinthosewhorequireiodinatedcontrast,whichmaybeachievedbypoint-of-carecreatininetestingorbyquestionnaire-basedriskassessmentforfactorssuchasdiabetes,cardiovasculardiseaseandCKD(notgraded).•Avoid/minimisecontrastifpossibleinthoseatriskofCI-AKI(notgraded)anduseiso-osmolarorlow-osmolarcontrastinthosewithincreasedrisk(level1B).Inthehead-to-headcomparisonsofiso-osmolarversuslow-osmolarcontrast,nodefinitivedifferencesinincidenceofCI-AKIwerefound.•UseofintravenoussalineorsodiumbicarbonateinthoseatriskofCI-AKI(level1A).Acomprehensivereviewof23studiescomparingbicarbonatetosalinefoundnoclearevidencethatbicarbonatewassuperiortosaline[16].•UseoforalNACwithfluidsinthoseatrisk(level2D).•Norolefororalfluidsalone(level1C).•Noroleforhaemodialysis/haemofiltrationforcontrastremovalinthosewithincreasedriskofCI-AKI(level2C).Itisworthpointingoutthatdespitetherecommendationforintravenousfluidloadingratherthanoralfluidloading,thereislittlehead-to-headcomparisonbetweenthetwoapproaches.ThevolumeoffluidingestedappearstobeanimportantpredictorofCI-AKIandarecentstudyoforalversusintravenousfluidsfoundnodifferenceinCI-AKIinmildCKD[17,18].GiventheexpenseofintravenoustherapyforallatriskofCI-AKI,theuseoforalfluidloadingmaybejustifiedinthose‘well’outpatientswithmildCKD.ConcerningNAC,theguidelinesrecognisethatthereissignificantheterogeneityinthedataandtheeffectsappearmodest,butsupportitsuseonthegroundsthatitisacheapandsafeintervention.ItisworthnotingthattheoralbioavailabilityofNACmaybelessthan10%andinterpretationofitseffectsinCI-AKImaybeconfoundedbytheactionofNAContubularsecretionofcreatinine.Finally,thereisconflictingdataregardingthevalueofprophylactichaemodialysis/haemofiltrationonCI-AKI,whichisreflectedinthelevel2Cgradingoftheguideline[19,20,21].DialysisInterventionsfortheTreatmentofAKIThissectionoftheguidelinescoversavarietyofissuesincludinginitiationandwithdrawalofRRT,anticoagulation,vascularaccess,membraneuse,modalityanddoseofRRT,andbuffersolutionuse.Atotalof30recommendationstatementsaremadeandsomeofthekeyrecommendationsaresummarisedintable3.Table 3KeyrecommendationsfordialysisinterventionsfortreatmentofAKITheuseofcitrateisrecommendedforpatientsoncontinuousRRT(CRRT),mainlyonthebasisofalargerandomisedcontrolledtrialinvolving200patientsshowingthatitsusewasassociatedwithfewercomplications(e.g.bleedingandthrombocytopenia)[22].Itisimportanttonotethatthecomparatorarmwasgivenlow-molecular-weightheparinwithoutanymonitoringwhichmayhavedriventheeventrateinthatgroup.TherequirementsforcomplexprotocolswithadditionalcalciuminfusionsandintensivemonitoringmaylimitthewidespreaduseofcitrateinCRRT.Furthermore,citrateiscontraindicatedinthosewithliverdiseaseorshockstates–theverypatientswhoaremostlikelytorequireCRRTontheintensivecare.ThesuggestionthatCRRTbeusedratherthanintermittenthaemodialysisforhaemodynamicallyunstablepatientsagaincontrastswiththeactualevidenceassetoutinaCochranemeta-analysis,whichfailedtoshowanydifferenceinhaemodynamicinstabilityormortalitybetweenthetwomodalities[23].WhilstCRRTappearedtobeassociatedwithlessescalationofvasopressorswithhighermeanarterialpressureattheendoftherapy,italsoappearedtobeassociatedwithahigherriskofclottedfilters.Furthermore,thereislittledatacomparingCRRTtoeithersustainedlow-efficiencydialysis(SLED)orprotocol-drivenmanagementtoimprovethestabilityofhaemodialysis(e.g.dialysatecooling,sodiumprofiling,stoppingvasodilatortherapy,‘extendedslow’dialysis).ThereisscantdataonthefeasibilityofperitonealdialysisinthemanagementofAKIanditsuseappearstobeprimarilylimitedtothepaediatricpopulationorresource-poorareas.TheguidelinesrecommenddialysisdosebemeasuredthoughtheuseofKt/VasamarkerofdialysisdoseinAKI,butthisisfraughtwithdifficultygiventhevariationsinureagenerationwithpatientsnotbeinginsteadystate.TherecommendedKt/Vof3.9appearstobederivedfromtheVeteransAffairs/NIHAcuteRenalFailureTrialNetwork.WhilethislargerandomisedcontrolledtrialfailedtoshowanybenefitofincreasingRRTdose,theaverageKt/Vinthelessintensivegroupwas3.9perweek[24].ThosepatientsonCRRTinthistrialhadaminimumeffluentflowof20ml/kg/hwhilstalargestudyofCRRTdosefromAustralasiashowednodifferencebetweeneffluentflowratesof25and40ml/kg/h–hencetherecommendationofaminimumeffluentvolumeof20–25ml/kg/h[25].ConclusionsAswithpreviousKDIGOguidelines,therecommendationsonAKIarebasedonanexhaustiveevidence-basedreviewoftheliteratureandprovidewelcomeguidanceforpracticeforclinicians.Theclearmessageisthatthereisalackofevidence(particularly,well-designedinterventionaloutcomestudies)tounderpinmuchofoureverydayclinicalpractice.Indeedonly14.8%oftherecommendationsweregraded‘1A’whilst63.9%oftherecommendationswerelevel2.Thus,thesearenotprescriptiveguidelines,butprovidenuancedguidancefortheclinician.TheKDIGOco-chairsbullishlyarguethatrecommendationsshouldbemadeevenwhentheevidenceisweak,ascliniciansoftenask‘Whatdotheexpertsdo?’–thismaybetrue,butashistorytellsus,thetrackrecordofexpertopinionintheabsenceofevidencecanoftenbedeeplyflawed.Thus,itisessentialthatpracticingcliniciansusingtheseguidelinesdistinguishexpertopinionfromevidence-basedrecommendationsand(astheKDIGOco-chairsrecommend)usetheseguidelinesto‘start,notstop,theirinquiriesintospecificmanagementquestions’.TherecommendationthatanempiricaldefinitionandstagingsystembeusedinthemanagementofAKIwillarousecontroversyanddebate.Asofyet,nodatahasbeenpresentedtoshowthatthesetoolsinthemselvescanimproveoutcomesinAKIandmanyclinicianswillbewaryaboutimplementingwhatisessentiallyaresearch-baseddiagnosticandstagingsystemintotheclinicalarenaintheabsenceofsuchdata. References ChertowGM,BurdickE,HonourM,BonventreJV,BatesDW:Acutekidneyinjury,mortality,lengthofstay,andcostsinhospitalizedpatients.JAmSocNephrol2005;16:3365–3370. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience NCEPODReport.AcuteKidneyInjury–AddingInsulttoInjury.2009.http://www.ncepod.org.uk/2009aki.htm. CerdaJ,BaggaA,KherV,ChakravarthiRM:Thecontrastingcharacteristicsofacutekidneyinjuryindevelopedanddevelopingcountries.NatClinPractNephrol2008;4:138–153. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience ClinicalPracticeGuidelinesforAcuteKidneyInjury2012.http://www.kdigo.org/clinical_practice_guidelines/AKI.php. MehtaRL,KellumJA,ShahSV,MolitorisBA,RoncoC,WarnockDG,LevinA:Acutekidneyinjurynetwork:reportofaninitiativetoimproveoutcomesinacutekidneyinjury.CritCare2007;11:R31. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience AliT,KhanI,SimpsonW,PrescottG,TownendJ,SmithW,MacleodA:Incidenceandoutcomesinacutekidneyinjury:acomprehensivepopulation-basedstudy.JAmSocNephrol2007;18:1292–1298. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience JoannidisM,MetnitzB,BauerP,SchusterschitzN,MorenoR,DrumlW,MetnitzPG:AcutekidneyinjuryincriticallyillpatientsclassifiedbyAKINversusRIFLEusingtheSAPS3database.IntensiveCareMed2009;35:1692–1702. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience ThakarCV,ChristiansonA,FreybergR,AlmenoffP,RenderML:Incidenceandoutcomesofacutekidneyinjuryinintensivecareunits:aVeteransAdministrationstudy.CritCareMed2009;37:2552–2558. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience CocaSG,YusufB,ShlipakMG,GargAX,ParikhCR:Long-termriskofmortalityandotheradverseoutcomesafteracutekidneyinjury:asystematicreviewandmeta-analysis.AmJKidneyDis2009;53:961–973. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience WaldR,QuinnRR,LuoJ,LiP,ScalesDC,MamdaniMM,RayJG:Chronicdialysisanddeathamongsurvivorsofacutekidneyinjuryrequiringdialysis.JAMA2009;302:1179–1185. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience FinferS,BellomoR,BoyceN,FrenchJ,MyburghJ,NortonR:Acomparisonofalbuminandsalineforfluidresuscitationintheintensivecareunit.NEnglJMed2004;350:2247–2256. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience WiedermannCJ,DunzendorferS,GaioniLU,ZaracaF,JoannidisM:Hyperoncoticcolloidsandacutekidneyinjury:ameta-analysisofrandomizedtrials.CritCare2010;14:R191. ExternalResources Crossref(DOI) Pubmed/Medline(NLM) ISIWebofScience GriesdaleDE,deSouzaRJ,vanDamRM,HeylandDK,CookDJ,MalhotraA,DhaliwalR,HendersonWR,ChittockDR,FinferS,TalmorD:Intensiveinsulintherapyandmortalityamongcriticallyillpatients:ameta-analysisincludingNICE-SUGARstudydata.CMAJ2009;180:821–827. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience JabaraR,GadesamRR,PendyalaLK,KnopfWD,ChronosN,ChenJP,VielK,KingSB3rd,ManoukianSV:Impactofthedefinitionutilizedontherateofcontrast-inducednephropathyinpercutaneouscoronaryintervention.AmJCardiol2009;103:1657–1662. ExternalResources Crossref(DOI) ISIWebofScience McCulloughPA,WolynR,RocherLL,LevinRN,O’NeillWW:Acuterenalfailureaftercoronaryintervention:incidence,riskfactors,andrelationshiptomortality.AmJMed1997;103:368–375. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) CambridgeScientificAbstracts(CSA) ISIWebofScience ZoungasS,NinomiyaT,HuxleyR,CassA,JardineM,GallagherM,PatelA,Vasheghani-FarahaniA,SadighG,PerkovicV:Systematicreview:sodiumbicarbonatetreatmentregimensforthepreventionofcontrast-inducednephropathy.AnnInternMed2009;151:631–638. ExternalResources ISIWebofScience YoshikawaD,IsobeS,SatoK,OhashiT,FujiwaraY,OhyamaH,IshiiH,MuroharaT:Importanceoforalfluidintakeaftercoronarycomputedtomographyangiography:anobservationalstudy.EurJRadiol2011;77:118–122. ExternalResources Crossref(DOI) ISIWebofScience ChoR,JavedN,TraubD,KodaliS,AtemF,SrinivasanV:Oralhydrationandalkalinizationisnoninferiortointravenoustherapyforpreventionofcontrast-inducednephropathyinpatientswithchronickidneydisease.JIntervCardiol2010;23:460–466. ExternalResources Crossref(DOI) ISIWebofScience CruzDN,GohCY,MarenziG,CorradiV,RoncoC,PerazellaMA:Renalreplacementtherapiesforpreventionofradiocontrast-inducednephropathy:asystematicreview.AmJMed2012;125:66–78e63. ExternalResources Crossref(DOI) ISIWebofScience LeePT,ChouKJ,LiuCP,MarGY,ChenCL,HsuCY,FangHC,ChungHM:Renalprotectionforcoronaryangiographyinadvancedrenalfailurepatientsbyprophylactichemodialysis.Arandomizedcontrolledtrial.JAmCollCardiol2007;50:1015–1020. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience MarenziG,LauriG,CampodonicoJ,MaranaI,AssanelliE,DeMetrioM,GraziM,VegliaF,FabbiocchiF,MontorsiP,BartorelliAL:Comparisonoftwohemofiltrationprotocolsforpreventionofcontrast-inducednephropathyinhigh-riskpatients.AmJMed2006;119:155–162. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience Oudemans-vanStraatenHM,BosmanRJ,KoopmansM,vanderVoortPH,WesterJP,vanderSpoelJI,DijksmanLM,ZandstraDF:Citrateanticoagulationforcontinuousvenovenoushemofiltration.CritCareMed2009;37:545–552. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience RabindranathK,AdamsJ,MacleodAM,MuirheadN:Intermittentversuscontinuousrenalreplacementtherapyforacuterenalfailureinadults.CochraneDatabaseSystRev2007;3:CD003773. PalevskyPM,ZhangJH,O’ConnorTZ,ChertowGM,CrowleyST,ChoudhuryD,FinkelK,KellumJA,PaganiniE,ScheinRM,SmithMW,SwansonKM,ThompsonBT,VijayanA,WatnickS,StarRA,PeduzziP:Intensityofrenalsupportincriticallyillpatientswithacutekidneyinjury.NEnglJMed2008;359:7–20. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience lomoR,CassA,ColeL,FinferS,GallagherM,LoS,McArthurC,McGuinnessS,MyburghJ,NortonR,ScheinkestelC,SuS:Intensityofcontinuousrenal-replacementtherapyincriticallyillpatients.NEnglJMed2009;361:1627–1638. ExternalResources Crossref(DOI) ISIWebofScience AuthorContacts Dr.ArifKhwaja,PhD,FRCPSheffieldKidneyInstitute,NorthernGeneralHospitalHerriesRoadSheffieldS57AU(UK)Tel.+441142714808,[email protected] Article/PublicationDetails Publishedonline:August07,2012 Issuereleasedate:October2012 NumberofPrintPages:6 NumberofFigures:0 NumberofTables:3 eISSN:1660-2110(Online) Foradditionalinformation:https://www.karger.com/NEC Copyright/DrugDosage/Disclaimer Copyright:Allrightsreserved.Nopartofthispublicationmaybetranslatedintootherlanguages,reproducedorutilizedinanyformorbyanymeans,electronicormechanical,includingphotocopying,recording,microcopying,orbyanyinformationstorageandretrievalsystem,withoutpermissioninwritingfromthepublisher. DrugDosage:Theauthorsandthepublisherhaveexertedeveryefforttoensurethatdrugselectionanddosagesetforthinthistextareinaccordwithcurrentrecommendationsandpracticeatthetimeofpublication.However,inviewofongoingresearch,changesingovernmentregulations,andtheconstantflowofinformationrelatingtodrugtherapyanddrugreactions,thereaderisurgedtocheckthepackageinsertforeachdrugforanychangesinindicationsanddosageandforaddedwarningsandprecautions.Thisisparticularlyimportantwhentherecommendedagentisanewand/orinfrequentlyemployeddrug. Disclaimer:Thestatements,opinionsanddatacontainedinthispublicationaresolelythoseoftheindividualauthorsandcontributorsandnotofthepublishersandtheeditor(s).Theappearanceofadvertisementsor/andproductreferencesinthepublicationisnotawarranty,endorsement,orapprovaloftheproductsorservicesadvertisedoroftheireffectiveness,qualityorsafety.Thepublisherandtheeditor(s)disclaimresponsibilityforanyinjurytopersonsorpropertyresultingfromanyideas,methods,instructionsorproductsreferredtointhecontentoradvertisements. References ChertowGM,BurdickE,HonourM,BonventreJV,BatesDW:Acutekidneyinjury,mortality,lengthofstay,andcostsinhospitalizedpatients.JAmSocNephrol2005;16:3365–3370. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience NCEPODReport.AcuteKidneyInjury–AddingInsulttoInjury.2009.http://www.ncepod.org.uk/2009aki.htm. CerdaJ,BaggaA,KherV,ChakravarthiRM:Thecontrastingcharacteristicsofacutekidneyinjuryindevelopedanddevelopingcountries.NatClinPractNephrol2008;4:138–153. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience ClinicalPracticeGuidelinesforAcuteKidneyInjury2012.http://www.kdigo.org/clinical_practice_guidelines/AKI.php. MehtaRL,KellumJA,ShahSV,MolitorisBA,RoncoC,WarnockDG,LevinA:Acutekidneyinjurynetwork:reportofaninitiativetoimproveoutcomesinacutekidneyinjury.CritCare2007;11:R31. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience AliT,KhanI,SimpsonW,PrescottG,TownendJ,SmithW,MacleodA:Incidenceandoutcomesinacutekidneyinjury:acomprehensivepopulation-basedstudy.JAmSocNephrol2007;18:1292–1298. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience JoannidisM,MetnitzB,BauerP,SchusterschitzN,MorenoR,DrumlW,MetnitzPG:AcutekidneyinjuryincriticallyillpatientsclassifiedbyAKINversusRIFLEusingtheSAPS3database.IntensiveCareMed2009;35:1692–1702. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience ThakarCV,ChristiansonA,FreybergR,AlmenoffP,RenderML:Incidenceandoutcomesofacutekidneyinjuryinintensivecareunits:aVeteransAdministrationstudy.CritCareMed2009;37:2552–2558. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience CocaSG,YusufB,ShlipakMG,GargAX,ParikhCR:Long-termriskofmortalityandotheradverseoutcomesafteracutekidneyinjury:asystematicreviewandmeta-analysis.AmJKidneyDis2009;53:961–973. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience WaldR,QuinnRR,LuoJ,LiP,ScalesDC,MamdaniMM,RayJG:Chronicdialysisanddeathamongsurvivorsofacutekidneyinjuryrequiringdialysis.JAMA2009;302:1179–1185. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience FinferS,BellomoR,BoyceN,FrenchJ,MyburghJ,NortonR:Acomparisonofalbuminandsalineforfluidresuscitationintheintensivecareunit.NEnglJMed2004;350:2247–2256. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience WiedermannCJ,DunzendorferS,GaioniLU,ZaracaF,JoannidisM:Hyperoncoticcolloidsandacutekidneyinjury:ameta-analysisofrandomizedtrials.CritCare2010;14:R191. ExternalResources Crossref(DOI) Pubmed/Medline(NLM) ISIWebofScience GriesdaleDE,deSouzaRJ,vanDamRM,HeylandDK,CookDJ,MalhotraA,DhaliwalR,HendersonWR,ChittockDR,FinferS,TalmorD:Intensiveinsulintherapyandmortalityamongcriticallyillpatients:ameta-analysisincludingNICE-SUGARstudydata.CMAJ2009;180:821–827. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience JabaraR,GadesamRR,PendyalaLK,KnopfWD,ChronosN,ChenJP,VielK,KingSB3rd,ManoukianSV:Impactofthedefinitionutilizedontherateofcontrast-inducednephropathyinpercutaneouscoronaryintervention.AmJCardiol2009;103:1657–1662. ExternalResources Crossref(DOI) ISIWebofScience McCulloughPA,WolynR,RocherLL,LevinRN,O’NeillWW:Acuterenalfailureaftercoronaryintervention:incidence,riskfactors,andrelationshiptomortality.AmJMed1997;103:368–375. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) CambridgeScientificAbstracts(CSA) ISIWebofScience ZoungasS,NinomiyaT,HuxleyR,CassA,JardineM,GallagherM,PatelA,Vasheghani-FarahaniA,SadighG,PerkovicV:Systematicreview:sodiumbicarbonatetreatmentregimensforthepreventionofcontrast-inducednephropathy.AnnInternMed2009;151:631–638. ExternalResources ISIWebofScience YoshikawaD,IsobeS,SatoK,OhashiT,FujiwaraY,OhyamaH,IshiiH,MuroharaT:Importanceoforalfluidintakeaftercoronarycomputedtomographyangiography:anobservationalstudy.EurJRadiol2011;77:118–122. ExternalResources Crossref(DOI) ISIWebofScience ChoR,JavedN,TraubD,KodaliS,AtemF,SrinivasanV:Oralhydrationandalkalinizationisnoninferiortointravenoustherapyforpreventionofcontrast-inducednephropathyinpatientswithchronickidneydisease.JIntervCardiol2010;23:460–466. ExternalResources Crossref(DOI) ISIWebofScience CruzDN,GohCY,MarenziG,CorradiV,RoncoC,PerazellaMA:Renalreplacementtherapiesforpreventionofradiocontrast-inducednephropathy:asystematicreview.AmJMed2012;125:66–78e63. ExternalResources Crossref(DOI) ISIWebofScience LeePT,ChouKJ,LiuCP,MarGY,ChenCL,HsuCY,FangHC,ChungHM:Renalprotectionforcoronaryangiographyinadvancedrenalfailurepatientsbyprophylactichemodialysis.Arandomizedcontrolledtrial.JAmCollCardiol2007;50:1015–1020. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience MarenziG,LauriG,CampodonicoJ,MaranaI,AssanelliE,DeMetrioM,GraziM,VegliaF,FabbiocchiF,MontorsiP,BartorelliAL:Comparisonoftwohemofiltrationprotocolsforpreventionofcontrast-inducednephropathyinhigh-riskpatients.AmJMed2006;119:155–162. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience Oudemans-vanStraatenHM,BosmanRJ,KoopmansM,vanderVoortPH,WesterJP,vanderSpoelJI,DijksmanLM,ZandstraDF:Citrateanticoagulationforcontinuousvenovenoushemofiltration.CritCareMed2009;37:545–552. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ISIWebofScience RabindranathK,AdamsJ,MacleodAM,MuirheadN:Intermittentversuscontinuousrenalreplacementtherapyforacuterenalfailureinadults.CochraneDatabaseSystRev2007;3:CD003773. PalevskyPM,ZhangJH,O’ConnorTZ,ChertowGM,CrowleyST,ChoudhuryD,FinkelK,KellumJA,PaganiniE,ScheinRM,SmithMW,SwansonKM,ThompsonBT,VijayanA,WatnickS,StarRA,PeduzziP:Intensityofrenalsupportincriticallyillpatientswithacutekidneyinjury.NEnglJMed2008;359:7–20. ExternalResources Pubmed/Medline(NLM) Crossref(DOI) ChemicalAbstractsService(CAS) ISIWebofScience lomoR,CassA,ColeL,FinferS,GallagherM,LoS,McArthurC,McGuinnessS,MyburghJ,NortonR,ScheinkestelC,SuS:Intensityofcontinuousrenal-replacementtherapyincriticallyillpatients.NEnglJMed2009;361:1627–1638. ExternalResources Crossref(DOI) ISIWebofScience Tables ArticleTools GetPermission PubMedID CitationDownload Text-File RIS-File WebofScienceCitations:2159 AddtomyReadingList RemovefrommyReadingList ArticleDetails 2012,Vol.120,No.4 October2012 PREV Article NEXT RecommendThis SOCIALMEDIA SOCIALMEDIA ABOUTUS Careers Company Contact KargerBlog Newsroom People RegionalOffices RESOURCES Catalogue&PriceList Downloads Help Rights&Permissions Terms&Conditions SERVICES Authors Booksellers Industry Librarians Readers Societies PrivacyPolicy|TermsofUse|Imprint|Cookies KargerInternational:COM|CN ©2022S.KargerAG,Basel PrivacyPolicy|TermsofUse|Imprint|Cookies KargerInternational:COM|CN ©2022S.KargerAG,Basel OURSERVICES OURCONTENT PUBLISHWITHUS ABOUTUS RESOURCES Catalogue&PriceList Downloads Help Rights&Permissions Terms&Conditions × SignupforMyKarger ManagewithMyKargeryourorderssimplyandfast,saveyourfavoritearticlesinyourreadinglist,edityournewsletterprofileandbenefitfromattractivediscounts. E-mailaddress Next ThissiteisprotectedbyreCAPTCHAandtheGooglePrivacyPolicyandTermsofServiceapply. LogintoMyKarger? WefoundanalreadyexistingMyKargeraccountwiththise-mailaddress: Hidepassword Password Keepmeloggedin Login Forgotpassword CompleteYourName FirstName LastName IhavereadtheKargerTermsandConditionsandagree. createaccount ThankYouforRegistering YourMyKargeraccounthasbeencreated. Checkyoure-mails,aswejustsentyouaverificatione-mail. Setyourpasswordbyclickingthelinkinthee-mail. Thelinkwillleadyoubacktothispagewhereyoucanproceed. done × ResetYourPassword Toresetyourpassword,enteryoure-mailaddressoryouruserIDyouregisteredwith.Youwillbesentane-mailcontainingalinktoresetyourpassword. E-mailaddress/UserID Somethingwentwrong Submit CheckYourE-Mails Alinktoresetyourpasswordhasbeensenttoyoure-mailaddress.Followtheinstructionsandtrytologinagain. Close TOP