Renal protection in the 21st century.
Among critically ill patients, acute kidney injury (AKI) is still a common and serious complication with a tremendous impact on short-term and long-term outcomes. The objective of this review is to discuss strategies for renal protection and prevention of AKI in ICU patients.



It is fundamental to identify patients at risk for AKI as soon as possible and as accurately as possible. In order to achieve these goals, translational approaches implementing new biomarkers have shown promising results. Focusing on the role of potential preventive strategies, hemodynamic stabilization is the most important intervention with proven efficacy. Recent published data undermined any hope that high-dose statin therapy in statin-naïve patients could exert renoprotective effects. However, preliminary data revealed the renoprotective activity of dexmedetomidine when used as a sedative agent. Moreover, several studies demonstrated the protective effects of remote ischemic preconditioning in various organs including the kidneys. The use of balanced crystalloid instead of hyperchloremic solutions also contributes to the reduction of AKI in critically ill patients.



To prevent AKI, it is crucial to identify patients at risk as early as possible. Establishing hemodynamic stability and an adequate intravascular volume state to ensure a sufficient perfusion pressure is the only effective therapeutic intervention. It is self-evident that nephrotoxic agents should be avoided whenever it is possible.
Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany.
Melanie
M
Meersch
Alexander
A
Zarbock
D058186:Acute Kidney Injury / Q000517:prevention & control* / Q000628:therapy*; D003422:Critical Care / Q000379:methods* / Q000639:trends*; D016638:Critical Illness; D000077324:Crystalloid Solutions; D020927:Dexmedetomidine / Q000008:administration & dosage; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007552:Isotonic Solutions; D007668:Kidney / Q000503:physiopathology
D000077324:Crystalloid Solutions; D006993:Hypnotics and Sedatives; D007552:Isotonic Solutions; D020927:Dexmedetomidine