Evidence base: Acute kidney injury

A summary of the clinical trials, guidelines, key texts and online resources to help in the management of acute kidney injury.

Haemodialysis or haemofiltration should be started before the onset of potentially fatal complications (Photograph: SPL)
Haemodialysis or haemofiltration should be started before the onset of potentially fatal complications (Photograph: SPL)

 Clinical trials

This study looked at the epidemiology of AKI in the US and found it was associated with a prolonged hospital stay of two days and an adjusted odds ratio of 4.1 for hospital mortality. It illustrated the cost effects of AKI on the health service.

This meta-analysis of nine RCTs found that furosemide is not associated with any clinical benefits in the prevention and treatment of AKI, but increases the risk of ototoxicity.   

Guidelines

  • DoH. National service framework for renal services – part two: Chronic kidney disease acute renal failure and end of life care. DoH, London, 2010.
  • NICE. Acutely ill patients in hospital. CG50, NICE, London, 2007.
  • The Renal Association. Acute kidney injury. 2010. www.renal.org/Clinical/GuidelinesSection/AcuteKidneyInjury.aspx

Key text

  • Steddon S, Ashman N, Chesser A, et al. Oxford Handbook of nephrology and hypertension. Oxford University Press, 2007, Oxford.
  • Ronco C, Bellomo R, Kellum J. Acute kidney injury. Basal, Karger, 2007.

Online    

  • The National Confidential Enquiry into Patient Outcomes and Death. Adding insult to injury. 2009. www.ncepod.org.uk

This report investigated the management of patients who died as result of AKI and highlighted the failings in their clinical care. The report inclu­ded recommendations for the early diagnosis, prevention and management of AKI.

KDIGO is a global foundation dedicated to improving the care and outcomes of kidney disease patients. It has five global clinical practice guidelines in nephrology under development.

 

Contributed by Dr Hannah Kilbride, specialist registrar, and Dr Marlies Ostermann, consultant in nephrology and critical care, Guy's and St Thomas' NHS Foundation Trust London.

 

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