title: The intensive care medicine agenda on acute kidney injury.
abstract: Acute kidney injury (AKI) is a common complication in the critically ill. Current standard of care mainly relies on identification of patients at risk, haemodynamic optimization, avoidance of nephrotoxicity and the use of renal replacement therapy (RRT) in established AKI. The detection of early biomarkers of renal tissue damage is a recent development that allows amending the late and insensitive diagnosis with current AKI criteria. Increasing evidence suggests that the consequences of an episode of AKI extend long beyond the acute hospitalization. Citrate has been established as the anticoagulant of choice for continuous RRT. Conflicting results have been published on the optimal timing of RRT and on the renoprotective effect of remote ischaemic preconditioning. Recent research has contradicted that acute tubular necrosis is the common pathology in AKI, that septic AKI is due to global kidney hypoperfusion, that aggressive fluid therapy benefits the kidney, that vasopressor therapy harms the kidney and that high doses of RRT improve outcome. Remaining uncertainties include the impact of aetiology and clinical context on pathophysiology, therapy and prognosis, the clinical benefit of biomarker-driven interventions, the optimal mode of RRT to improve short- and long-term patient and kidney outcomes, the contribution of AKI to failure of other organs and the optimal approach for assessing and promoting renal recovery. Based on the established gaps in current knowledge the trials that must have priority in the coming 10 years are proposed together with the definition of appropriate clinical endpoints.
authors.affiliation: Department of Intensive Care Medicine (710), Radboud University Medical Centre, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.affiliation: Department of Critical Care, Guy's and St Thomas' Hospital, King's College London, London, SE1 9RT, UK.
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
authors.affiliation: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Joannidis
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer Campus 1, Building A1, 48149, Münster, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zarbock
authors.affiliation: Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.|Research Foundation-Flanders, Brussels, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Hoste
authors.affiliation: School of Medicine, The University of Melbourne, Melbourne, VIC, Australia.|Department of Intensive Care, Austin Hospital Heidelberg, Melbourne, VIC, 3084, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK.|Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Prowle
authors.affiliation: Medical-Surgical ICU, Saint-Etienne University Hospital and Jacques Lisfranc Medical School, Saint-Etienne, 42000, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Bonventre
authors.affiliation: Surrey Perioperative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital, NHS Foundation Trust and School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.|Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, UK.
authors.forename: Lui
authors.initials: L
authors.lastname: Forni
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 ST NW, Edmonton, AB, T6G2B7, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven University, Herestraat 49, B3000, Louvain, Belgium. marie.schetz@uzleuven.be.
authors.forename: Miet
authors.initials: M
authors.lastname: Schetz
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D015415:Biomarkers / Q000032:analysis / Q000652:urine; D003422:Critical Care / Q000379:methods / Q000592:standards; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D059039:Standard of Care; D013997:Time Factors
chemical_list: D015415:Biomarkers
keywords: Acute kidney injury; Biomarkers; Fluid therapy; Renal replacement therapy; Research agenda; Trial endpoints