New KDIGO Guideline Helps Define, Diagnose and Manage Acute Kidney Injury

NEW YORK, NY (March 19,2012)— Early detection and proper diagnosis of acute kidney injury  (AKI) are essential to preventing cardiovascular events, kidney failure and mortality, according to the first evidence-based clinical practice guideline for AKI. Published this month inKidney International Supplements, the guideline was developed by an international group of experts co-chaired by John A. Kellum, MD, professor of Critical Care Medicine at the University of Pittsburgh and Norbert Lameire MD, PhD, of Ghent University Hospital in Ghent, Belgium, under the auspices of Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO is managed by the National Kidney Foundation.

“Although AKI presents similarly in so many patients,the root causes are varied,” said Dr. Kellum. “And that’s why it’s critical for doctors to find it early and determine the underlying cause of each case. Treatment and response to treatment will differ accordingly and AKI is linked not only to short term patient outcomes, but to long term ones as well. This guideline offers a roadmap for physicians to assess and manage this common condition.”

Prior to the publication of this guideline, considerable variation existed in recommendations for prevention, evaluation, diagnosis and treatment. In developing this clinical practice guideline, an approach has been establishedto recognize and treat AKI on an individual basis. By assessing the comprehensive medical, social and drug history of each patient in addition to performing physical examination, this guideline outlines AKI management to improve patient outcomes and reduce costs.

“Acute kidney injury is a major problem with profound consequences that has long been under-recognized,” says Dr. Bertram L. Kasiske, co-chair of KDIGO. “Our collective attention has been on chronic kidney disease, and rightfully so. However, we now know that acute kidney injury may be a precursor to CKD, and CKD can also lead to AKI.”

The guideline provides a clear definition and staging systemfor AKI and a comprehensive guide for proper classification and evaluation, prevention and treatmentof AKI, including:

Evaluation

  • Diagnostic tools (urinary abnormalities, blood tests, biomarkers, imaging techniques)
  • Clinical settings to consider (community, in-hospital, ICU, developing countries)
  • Limitations (age, adults > 18 years, specific infectious and/or nephrotoxic insults)

Prevention

  • Susceptible groups and risk factors (genetic, clinical, age, baseline eGFR)
  • General measures (volume status, hemodynamic monitoring, urine flow, renal perfusion)
  • Pharmacologic interventions (diuretics, vasopressors, vasodilators, acetylcysteine)
  • Measures to consider in the use of drugs and procedures associated with AKI

Treatment and Prognosis

  • Non-dialytic (volume, anti-sepsis, ventilation, metabolic control, euglycemia)
  • Dialytic (type, dose, initiation, discontinuation, anticoagulants, access)
  • Scoring systems (recovery, mortality)
  • The interrelationship between AKI and CKD
  • Factors that determine general and renal recovery and outcome

To view the complete guideline, please click here

KDIGO Guideline Development Process
KDIGO employs an evidence based approach that is modeled on the guideline development process used in the NKF Kidney Disease Outcome Quality Initiative (KDOQI™) guidelines. It empowers an independent work group supported by evidence review experts to rigorously examine the published evidence and formulate practice guidelines. Before they are finalized, the draft guidelines undergo a two-stage review process: internal review by the KDIGO Board, followed by open peer review by interested organizations, agencies and individuals worldwide. Reviewer comments are carefully reviewed by the work group, and incorporated as appropriate, before the guidelines are finalized and published.
KDIGO, a global non-profit foundation managed by the National Kidney Foundation, is dedicated to improving the care and outcomes of kidney disease patients worldwide through promoting coordination, collaboration, and integration of initiatives to develop and implement clinical practices guidelines.
For more information on KDIGO, please visit www.kdigo.org