Can we prevent acute kidney injury?
OBJECTIVE
To review the literature on prevention of acute kidney injury (AKI).


METHODS
MEDLINE- and PubMed-based review of literature published from 1965 to 2007.


CONCLUSIONS
AKI is very common among critically ill patients. Even mild forms of AKI have significant attributable mortality. Hence, it is imperative that every effort to prevent AKI be made in clinical practice. However, there are very few interventions that have been shown to consistently prevent AKI. Measures such as adequate hydration, maintenance of adequate circulating blood volume and mean arterial pressure, and avoidance of nephrotoxins are still the mainstay of prevention. Loop diuretics and "renal-dose" dopamine have been clearly shown not to prevent AKI and may, in fact, do harm. Among the remaining pharmacologic options, N-acetylcysteine has the strongest evidence in prevention of AKI. Fenoldopam and theophylline need further investigation before being used to prevent septic AKI and contrast nephropathy, respectively. The role of prophylactic dialysis in preventing contrast nephropathy needs to be investigated further.
Venkataraman
Ramesh
R
Critical Care Consultants Group, Critical Care Medicine, Apollo Hospitals, Chennai, India. ccmramesh@gmail.com
D000111:Acetylcysteine / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects; D002626:Chemistry, Pharmaceutical; D003287:Contrast Media / Q000009:adverse effects; D003422:Critical Care; D003681:Dehydration / Q000150:complications / Q000517:prevention & control*; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000009:adverse effects
D000617:Aminoglycosides; D000935:Antifungal Agents; D003287:Contrast Media; D016166:Free Radical Scavengers; D049994:Sodium Potassium Chloride Symporter Inhibitors; D000666:Amphotericin B; D000111:Acetylcysteine