Acute kidney injury on admission to the intensive care unit: where to go from here?

Acute kidney injury (AKI) is a common problem, especially in critically ill patients. In Critical Care, Kolhe and colleagues report that 6.3% of 276,731 patients in 170 intensive care units (ICUs) in the UK had evidence of severe AKI within the first 24 hours of admission to ICU. ICU and hospital mortality as well as length of stay in hospital were significantly increased. In light of this serious burden on individuals and the health system in general, the following commentary discusses the current state of knowledge of AKI in ICU and calls for more attention to preventive strategies

Care of the Critically Ill Emergency Department Patient with Acute Kidney Injury

Introduction. Acute Kidney Injury (AKI) is common and associated with significant mortality and complications. Exact data on the epidemiology of AKI in the Emergency Department (ED) are sparse. This review aims to summarise the key principles for managing AKI patients in the ED. Principal Findings. Timely resuscitation, goal-directed correction of fluid depletion and hypotension, and appropriate management of the underlying illness are essential in preventing or limiting AKI. There is no specific curative therapy for AKI. Key principles of secondary prevention are identification of patients with early AKI, discontinuation of nephrotoxic medication where possible, attention to fluid resuscitation, and awareness of the risks of contrast-induced nephropathy. In patients with advanced AKI, arrangements for renal replacement therapy need to be made before the onset of life-threatening uraemic complications. Conclusions. Research and guidelines regarding AKI in the ED are lacking and AKI practice from critical care departments should be adopted

Management of sodium disorders during continuous haemofiltration

In patients with acute kidney injury and concomitant severe hyponatraemia or hypernatraemia, rapid correction of the serum Na+ concentration needs to be avoided. The present paper outlines the principles of how to adjust the Na+ concentration in the replacement fluid during continuous renal replacement therapy to prevent rapid changes of the serum Na+ concentration