Prevention of acute kidney injury in critically ill patients. Recommendations from the renal section of the DGIIN, OGIAIN and DIVI

Acute kidney injury (AKI) has both high mortality and morbidity. To prevent the occurrence of AKI, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft fur Internistische Intensivmedizin und Notfallmedizin), A-GIAIN (A-sterreichischen Gesellschaft fur Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinaren Vereinigung fur Intensiv- und Notfallmedizin) are stated. The recommendations stated in this paper are based on the current Kidney Disease Improving Global Outcomes (KDIGO) guidelines, the published statements of the Working Group on Prevention, AKI section of the European Society of Intensive Care Medicine and the expert knowledge and clinical experience of the authors. Currently there are no approved clinically effective drugs for the prevention of AKI. Therefore the mainstay of prevention is the optimization of renal perfusion by improving the mean arterial pressure (> 65 mm Hg, higher target may be considered in hypertensive patients). This can be done by vasopressors, preferably norepinephrine and achieving or maintaining euvolemia. Hyperhydration that can lead to AKI itself should be avoided. In patients with maintained diuresis this can be done by diuretics that are per se no preventive drug for AKI. Radiocontrast enhanced imaging should not be withheld from patients at risk for AKI; if indicated, however, the contrast media should be limited to the smallest possible volume.