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Management of patients at risk of acute kidney injury

(2017) LANCET. 389(10084). p.2139-2151
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Abstract
Acute kidney injury (AKI) is a multifaceted syndrome that occurs in different settings. The course of AKI can be variable, from single hit and complete recovery, to multiple hits resulting in end-stage renal disease. No interventions to improve outcomes of established AKI have yet been developed, so prevention and early diagnosis are key. Awareness campaigns and education for health-care professionals on diagnosis and management of AKI-with attention to avoidance of volume depletion, hypotension, and nephrotoxic interventions-coupled with electronic early warning systems where available can improve outcomes. Biomarker-based strategies have not shown improvements in outcome. Fluid management should aim for early, rapid restoration of circulatory volume, but should be more limited after the first 24-48 h to avoid volume overload. Use of balanced crystalloid solutions versus normal saline remains controversial. Renal replacement therapy should only be started on the basis of hard criteria, but should not be delayed when criteria are met. On the basis of recent evidence, the risk of contrast-induced AKI might be overestimated for many conditions.
Keywords
CONTRAST-INDUCED NEPHROPATHY, ACUTE-RENAL-FAILURE, RANDOMIZED, CLINICAL-TRIAL, INTENSIVE-CARE-UNIT, GELATINASE-ASSOCIATED LIPOCALIN, CRITICALLY-ILL PATIENTS, GOAL-DIRECTED RESUSCITATION, EARLY SEPTIC, SHOCK, CARDIAC-SURGERY, RESISTIVE INDEX

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Citation

Please use this url to cite or link to this publication:

Chicago
Vanmassenhove, Jill, Jan Kielstein, Achim Joerres, and Wim Van Biesen. 2017. “Management of Patients at Risk of Acute Kidney Injury.” Lancet 389 (10084): 2139–2151.
APA
Vanmassenhove, J., Kielstein, J., Joerres, A., & Van Biesen, W. (2017). Management of patients at risk of acute kidney injury. LANCET, 389(10084), 2139–2151.
Vancouver
1.
Vanmassenhove J, Kielstein J, Joerres A, Van Biesen W. Management of patients at risk of acute kidney injury. LANCET. 2017;389(10084):2139–51.
MLA
Vanmassenhove, Jill, Jan Kielstein, Achim Joerres, et al. “Management of Patients at Risk of Acute Kidney Injury.” LANCET 389.10084 (2017): 2139–2151. Print.
@article{8529257,
  abstract     = {Acute kidney injury (AKI) is a multifaceted syndrome that occurs in different settings. The course of AKI can be variable, from single hit and complete recovery, to multiple hits resulting in end-stage renal disease. No interventions to improve outcomes of established AKI have yet been developed, so prevention and early diagnosis are key. Awareness campaigns and education for health-care professionals on diagnosis and management of AKI-with attention to avoidance of volume depletion, hypotension, and nephrotoxic interventions-coupled with electronic early warning systems where available can improve outcomes. Biomarker-based strategies have not shown improvements in outcome. Fluid management should aim for early, rapid restoration of circulatory volume, but should be more limited after the first 24-48 h to avoid volume overload. Use of balanced crystalloid solutions versus normal saline remains controversial. Renal replacement therapy should only be started on the basis of hard criteria, but should not be delayed when criteria are met. On the basis of recent evidence, the risk of contrast-induced AKI might be overestimated for many conditions.},
  author       = {Vanmassenhove, Jill and Kielstein, Jan and Joerres, Achim and Van Biesen, Wim},
  issn         = {0140-6736},
  journal      = {LANCET},
  language     = {eng},
  number       = {10084},
  pages        = {2139--2151},
  title        = {Management of patients at risk of acute kidney injury},
  volume       = {389},
  year         = {2017},
}

Web of Science
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