Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup

Alexander Zarbock, Mitra K. Nadim, Peter Pickkers, Hernando Gomez, Samira Bell, Michael Joannidis, Kianoush Kashani, Jay L. Koyner, Neesh Pannu, Melanie Meersch, Thiago Reis, Thomas Rimmelé, Sean M. Bagshaw, Rinaldo Bellomo, Vicenzo Cantaluppi, Akash Deep, Silvia De Rosa, Xose Perez-Fernandez, Faeq Husain-Syed, Sandra L. Kane-GillYvelynne Kelly, Ravindra L Mehta, Patrick T. Murray, Marlies Ostermann, John Prowle, Zaccaria Ricci, Emily J. See, Antoine Schneider, Danielle E. Soranno, Ashita Tolwani, Gianluca Villa, Claudio Ronco, Lui G. Forni (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

Abstract

Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and is strongly associated with adverse outcomes, including an increased risk of chronic kidney disease, cardiovascular events and death. The pathophysiology of SA-AKI remains elusive, although microcirculatory dysfunction, cellular metabolic reprogramming and dysregulated inflammatory responses have been implicated in preclinical studies. SA-AKI is best defined as the occurrence of AKI within 7 days of sepsis onset (diagnosed according to Kidney Disease Improving Global Outcome criteria and Sepsis 3 criteria, respectively). Improving outcomes in SA-AKI is challenging, as patients can present with either clinical or subclinical AKI. Early identification of patients at risk of AKI, or at risk of progressing to severe and/or persistent AKI, is crucial to the timely initiation of adequate supportive measures, including limiting further insults to the kidney. Accordingly, the discovery of biomarkers associated with AKI that can aid in early diagnosis is an area of intensive investigation. Additionally, high-quality evidence on best-practice care of patients with AKI, sepsis and SA-AKI has continued to accrue. Although specific therapeutic options are limited, several clinical trials have evaluated the use of care bundles and extracorporeal techniques as potential therapeutic approaches. Here we provide graded recommendations for managing SA-AKI and highlight priorities for future research.

Original languageEnglish
Number of pages17
JournalNature Reviews Nephrology
Early online date23 Feb 2023
DOIs
Publication statusE-pub ahead of print - 23 Feb 2023

Keywords

  • Acute kidney injury
  • Infection
  • Prognostic markers
  • Sepsis

ASJC Scopus subject areas

  • Nephrology

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