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Improving outcomes of acute kidney injury: report of an initiative

Nature Clinical Practice Nephrology volume 3, pages 439–442 (2007)Cite this article

Abstract

Acute kidney injury (AKI) is a complex disorder comprising several etiological factors and occurring in multiple settings. The disorder has a variety of clinical manifestations that range from minimal elevation in serum creatinine level to anuric renal failure. We describe the formation of a multidisciplinary collaborative network focused on AKI. This Acute Kidney Injury Network has proposed uniform standards for diagnosing and classifying AKI. These proposed standards will need to be validated in future studies, a process that will be facilitated by the Acute Kidney Injury Network, which offers a forum that encourages acquisition of knowledge to improve patient outcomes.

Key Points

  • The large numbers of etiologies and risk factors associated with acute kidney injury (AKI) have led to the ad hoc development of a wide range of definitions of this condition

  • The lack of common standards for diagnosis and classification of AKI has hampered study of the condition and improvement of patient outcomes

  • At their first meeting in September 2005, members of the Acute Kidney Injury Network (AKIN) working group proposed new standards based on RIFLE criteria and recognition of the fact that small changes in serum creatinine level are associated with increased mortality

  • The common standards for diagnosis and classification of AKI proposed by AKIN will require validation

  • AKIN recommends that a broader international collaborative network be established to facilitate progress in AKI research, dissemination of knowledge, and implementation of standards of patient care

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References

  1. Mehta RL et al. (2004) Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 66: 1613–1621

    Article  Google Scholar 

  2. Metnitz PG et al. (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30: 2051–2058

    Article  Google Scholar 

  3. Uchino S et al. (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294: 813–818

    Article  CAS  Google Scholar 

  4. Liangos O et al. (2006) Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol 1: 43–51

    Article  Google Scholar 

  5. Chertow GM et al. (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16: 3365–3370

    Article  Google Scholar 

  6. Lassnigg A et al. (2004) Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 15: 1597–1605

    Article  CAS  Google Scholar 

  7. Levy MM et al. (2005) Early changes in organ function predict eventual survival in severe sepsis. Crit Care Med 33: 2194–2201

    Article  Google Scholar 

  8. McCullough PA and Soman SS (2005) Contrast-induced nephropathy. Crit Care Clin 21: 261–280

    Article  Google Scholar 

  9. Hoste EAJ et al. (2006) RIFLE criteria for acute kidney injury is associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10: R73

    Article  Google Scholar 

  10. Druml W (2005) Long term prognosis of patients with acute renal failure: is intensive care worth it? Intensive Care Med 31: 1145–1147

    Article  Google Scholar 

  11. Liaño F et al. (1998) The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 66: S16–S24

    PubMed  Google Scholar 

  12. Mehta RL et al. (2002) Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 288: 2547–2553

    Article  CAS  Google Scholar 

  13. Bellomo R et al. (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8: R204–R212

    Article  Google Scholar 

  14. Mehta RL et al. (2007) Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care 11: R31

    Article  Google Scholar 

  15. Bellomo R et al. (2004) Defining acute renal failure: physiological principles. Intensive Care Med 30: 33–37

    Article  Google Scholar 

  16. Han WK and Bonventre JV (2004) Biologic markers for the early detection of acute kidney injury. Curr Opin Crit Care 10: 476–482

    Article  Google Scholar 

  17. Perrone RD et al. (1992) Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem 38: 1933–1953

    CAS  Google Scholar 

Download references

Acknowledgements

In order to encourage dissemination of the information set out in this paper, it is freely accessible on the Nature Clinical Practice Nephrology website, and will also be published in the American Journal of Kidney Diseases, Clinical Journal of the American Society of Nephrology, Journal of the American Society of Nephrology, and Kidney International. This article has not been formally peer-reviewed.

Author information

Authors and Affiliations

  1. BA Molitoris is Director of the Division of Nephrology in the Department of Medicine, Indiana University, Indianapolis, IN, USA.,

    Bruce A Molitoris

  2. A Levin is Professor of Medicine in the Division of Nephrology, Director of the Kidney Function Clinic, St Paul's Hospital, and Co-Director of the Clinical Investigation Program, University of British Columbia, Vancouver, BC, Canada.,

    Adeera Levin

  3. DG Warnock is Director of the Division of Nephrology in the Department of Medicine, University of Alabama, Birmingham, AL, USA.,

    David G Warnock

  4. M Joannidis is Director of the Medical Intensive Care Unit in the Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.,

    Michael Joannidis

  5. RL Mehta is Professor of Clinical Medicine in the Department of Medicine, University of California San Diego Medical Center, San Diego, CA, USA.,

    Ravindra L Mehta

  6. JA Kellum is Professor in the Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,

    John A Kellum

  7. C Ronco is Head of the Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,

    Claudio Ronco

  8. SV Shah is Professor of Internal Medicine and Director of the Division of Nephrology, University of Arkansas for Medical Sciences, and Chief of the Renal Section, Medical Service, John L McClellan Memorial Veterans Hospital, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,

    Sudhir V Shah

Authors
  1. Bruce A Molitoris
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  2. Adeera Levin
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  3. David G Warnock
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  4. Michael Joannidis
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  5. Ravindra L Mehta
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on behalf of the Acute Kidney Injury Network working group

Corresponding author

Correspondence to Bruce A Molitoris.

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The authors declare no competing financial interests.

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Molitoris, B., Levin, A., Warnock, D. et al. Improving outcomes of acute kidney injury: report of an initiative. Nat Rev Nephrol 3, 439–442 (2007). https://doi.org/10.1038/ncpneph0551

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