Acute Kidney Injury

Acute Kidney Injury

Over the past few years, and for appropriate reasons, the field of acute kidney injury (AKI) has evolved at a rapid pace. Even the name acute renal failure (ARF) was changed to AKI, and ICD-9 codes adopted AKI in October 2008. The primary reason for the change in nomenclature was the repeated observation that pharmacological therapy of AKI has been unsuccessful despite proven benefits seen in preclinical studies.

Acute kidney injury (AKI) is a frequent complication in critically ill patients and is associated with a high mortality rate. Continuous renal replacement therapy (CRRT) represents a spectrum of dialysis modalities developed in the 1980s specifically for the management of critically ill patients with AKI who could not tolerate traditional intermittent renal replacement therapy (IRRT). Over the years, CRRT has found widespread use and acceptance due to its ability to provide effective volume and metabolic control in hemodynamically unstable patients.

The main therapeutic intervention for treatment of acute renal failure (ARF), extracorporeal renal replacement therapy (RRT) was introduced over half a century ago. RRT has changed the natural history of this disorder from a devastating condition that almost invariably led to the patient’s demise, to a manageable complication. Unfortunately, further improvement in survival rates among patients with ARF have at best been incremental, with mortality rates remaining unacceptably high (13).

Recent and important advances in acute kidney injury (AKI) research have focused primarily on: ( i) derivation and validation of multidimensional AKI definitions and classification systems, e.g., RIFLE (Risk, Injury, and Failure (1), pRIFLE (2), or the Acute Kidney Injury Network (AKIN) (3) definitions; (ii) demonstrating that even small serum creatinine increases (e.g., > 0.3 mg/dL) can be associated with increased patient mortality (4); and (iii) discovery and validation of novel urinary bioma