The development of successful therapeutic strategies
for the prevention and treatment of most forms of
AKI has been disappointing. Although numerous
agents have shown promise in experimental models,
none has demonstrated utility in clinical care. A
particular area of focus has been in the prevention of
contrast-induced AKI. This common cause ofAKI has
been the focus of multiple preventative interventions
because individuals at high risk of contrast-induced
AKI can be readily identified and the timing of
exposure can be predetermined, allowing an opportunity
for intervention. In the absence of effective pharmacologic
therapy, the management of established
AKI is predominantly supportive care, with the use of
RRT in severe AKI. There has been tremendous
advancement in the technology and modalities available
for providing RRT; however, the optimal approach
to management of RRT in this setting remains
controversial. The KDIGO AKI guideline provides
specific recommendations, based on the current literature,
for best practices in the prevention and management
of AKI. In this KDOQI commentary, we have
attempted to place this international guideline in the
context of care practices in the United States. However,
our commentary should be viewed in conjunction
with the full KDIGO document when making
clinical decisions.