title: Prevention and treatment of sepsis-induced acute kidney injury: an update.
abstract: Sepsis-induced acute kidney injury (SAKI) remains an important challenge in critical care medicine. We reviewed current available evidence on prevention and treatment of SAKI with focus on some recent advances and developments. Prevention of SAKI starts with early and ample fluid resuscitation preferentially with crystalloid solutions. Balanced crystalloids have no proven superior benefit. Renal function can be evaluated by measuring lactate clearance rate, renal Doppler, or central venous oxygenation monitoring. Assuring sufficiently high central venous oxygenation most optimally prevents SAKI, especially in the post-operative setting, whereas lactate clearance better assesses mortality risk when SAKI is present. Although the adverse effects of an excessive "kidney afterload" are increasingly recognized, there is actually no consensus regarding an optimal central venous pressure. Noradrenaline is the vasopressor of choice for preventing SAKI. Intra-abdominal hypertension, a potent trigger of AKI in post-operative and trauma patients, should not be neglected in sepsis. Early renal replacement therapy (RRT) is recommended in fluid-overloaded patients' refractory to diuretics but compelling evidence about its usefulness is still lacking. Continuous RRT (CRRT) is advocated, though not sustained by convincing data, as the preferred modality in hemodynamically unstable SAKI. Diuretics should be avoided in the absence of hypervolemia. Antimicrobial dosing during CRRT needs to be thoroughly reconsidered to assure adequate infection control.
authors.affiliation: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. Patrick.Honore@az.vub.ac.be.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Honore
authors.affiliation: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. Rita.Jacobs@uzbrussel.be.
authors.forename: Rita
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. Inne.Hendrickx@uzbrussel.be.
authors.forename: Inne
authors.initials: I
authors.lastname: Hendrickx
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. Sean.Bagshaw@albertahealthservices.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Haut Leveque University Hospital of Bordeaux, University of Bordeaux 2, Pessac, France. olivier.joannes-boyau@chu-bordeaux.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Joannes-Boyau
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium. wllm.br@gmail.com.
authors.forename: Willem
authors.initials: W
authors.lastname: Boer
authors.affiliation: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. Elisabeth.Dewaele@uzbrussel.be.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: De Waele
authors.affiliation: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. Viola.Vangorp@uzbrussel.be.
authors.forename: Viola
authors.initials: V
authors.lastname: Van Gorp
authors.affiliation: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. Herbert.Spapen@uzbrussel.be.
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Spapen
keywords: Acute kidney injury; Prevention; Review; Sepsis; Septic acute kidney injury; Treatment