The Future of AKI (Acute Kidney Injury): A Decade Beyond the KDIGO Guidelines

Welcome back to Niko’s Perioperative.

Because staying curious makes all the difference!

In this episode, we take a dive into the evolving world of Acute Kidney Injury (AKI) in anesthesiology. We explore the monumental changes and advancements that have occurred since the game-changing 2012 KDIGO guidelines were released. 

Throughout our conversation, we uncover the potential of cutting-edge biomarkers to revolutionize the early detection and management of AKI, offering us unprecedented insights into this critical condition. We navigate the ongoing controversies in fluid management—debating crystalloids; balanced solutions vs. normal saline, and restrictive vs. liberal fluid strategies—to uncover what the latest research says. We examine the complexities of blood pressure management during surgery, highlighting how individualized care is reshaping our approach to hemodynamic targets. We also debunk common myths surrounding AKI management and prevention. Looking ahead, we explore potential advancements in AKI care, including personalized medicine, the role of biomarkers in risk assessment, and the importance of understanding AKI trajectories.

Check all the references mentioned on the episode bellow ↓↓

Stay Curious!

References for this episode include:

1. Kellum, J. A., et al.(2012). Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements, 2(1), 1–138.
2. Haase, M., Kellum, J. A., & Ronco, C. (2012). Subclinical AKI - An emerging syndrome with important consequences. In Nature Reviews Nephrology (Vol. 8, Issue 12, pp. 735–739). 
3. Asfar, P.,  et al.(2014). High versus Low Blood-Pressure Target in Patients with Septic Shock (SEPSISPAM). The NEJM, 370(17), 1583–1593. 
4. Weisbord, S. D., et al.(2018). Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine (PRESERVE Trial). The NEJM, 378(7), 603–614.

Balanced solutions vs. normal saline

1. Young, P., et al. (2015). Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: The SPLIT randomized clinical trial. JAMA , 314(16), 1701–1710.
2. Self, W. H., et al. (2018). Balanced Crystalloids versus Saline in Noncritically Ill Adults (SALT-ED). New England Journal of Medicine, 378(9), 819–828. 
3. Semler, M. W., (2018). Balanced Crystalloids versus Saline in Critically Ill Adults. (SMART trial). The NEJM, 378(9), 829–839. 
4. Zampieri, F. G., et al. (2021). Effect of Intravenous Fluid Treatment with a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA, 326(9), 818–829. 
5. Finfer, S., et al.  (2022). Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. (PLUS Study) The NEJM, 386(9), 815–826.
6. Hammond, N. E., (2022). Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis. NEJM Evidence, 1(2). 

Restrictive vs. liberal approach.

1. Hjortrup, P. B., The CLASSIC Trial Group, & The Scandinavian Critical Care Trials Group. (2016). Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Medicine, 42(11), 1695–1705.
2. Meyhoff, T. S., et al.  (2022). Restriction of Intravenous Fluid in ICU Patients with Septic Shock (CLASSIC main Trial). The NEJM, 386(26), 2459–2470. 
3. Myles, P. S., et al.(2018). Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF). The NEJM, 378(24), 2263–2274. 
4. National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network (2023). Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension (CLOVERS). The NEJM, 388(6), 499–510.