The experts then highlighted the need for new biomarkers to identify incipient AKI. Serum creatinine remains the primary biomarker (in association with urine output, when available) for evaluating the clinical evolution of patients with AKI, and even small increases in creatinine have been shown to have a substantial impact on mortality.
The experts also made several recommendations based on the analysis of practices and outcomes.
While stressing the importance of adequate volume repletion for prevention of AKI, the statement cautioned that correction of fluid deficits will not always prevent renal failure. In fact, the researchers noted that "persistent fluid challenges" should be avoided in cases where a patient's hemodynamics are satisfactory if previous fluid challenges did not lead to improved in renal function or if oxygenation deteriorates. The statement also indicated that, while fluid resuscitation with crystalloids is effective and safe, hyperoncotic solutions are not recommended because of their renal risk.
In the case of kidney failure, the investigators noted that "renal replacement therapy is a life-sustaining intervention that can provide a bridge to renal recovery." That said, traditional triggers for this treatment derived from studies in chronic renal failure may not be appropriate for critically ill patients with AKI, and when renal support is indicated because of metabolic derangements, treatment should not be delayed.
The authors further noted that there is "no evidence that the use of intermittent hemodialysis or continuous hemofiltration clearly produce superior renal recovery or survival rates in general ICU patient populations," and stressed that performing intermittent hemodialysis in ICU pati
|Contact: Keely Savoie|
American Thoracic Society