KDIGO (Kidney Disease: Improving Global Outcomes)
is an international initiative to develop and
implement clinical practice guidelines for patients with
kidney disease. In March 2012, KDIGO published its
guideline for the evaluation and management of acute
kidney injury (AKI).1 This guideline covers numerous
topics, including the definition and classification of AKI,
the prevention and treatment of AKI in general with
specific recommendations for the prevention of contrastinduced
AKI, and the management of renal replacement
therapy (RRT) in patients with AKI. Because international
guidelines need to be adapted for the United
States, the National Kidney Foundation–Kidney Disease
Outcomes Quality Initiative (NKF-KDOQI) convened a
multidisciplinary work group with expertise in adult and
pediatric nephrology and critical care medicine to comment
on the applicability and implementation of the
KDIGO AKI guideline in the United States. This commentary
provides a summary of the KDIGO recommendation
statements along with the supporting rationales
and comments on their applicability to clinical practice
in the United States. The KDOQIWork Group congratulates
KDIGO, the members of the AKI Guideline Work
Group, and the evidence review team for producing such
a comprehensive document and believes that this guideline
will be of great value to health professionals and will
advance both current clinical care of patients with AKI
and future clinical research.
AKI represents the sudden loss of kidney function,
generally occurring over the course of hours to days
and resulting in the retention of metabolic waste
products and dysregulation of fluid, electrolyte, and
acid-base homeostasis. During the past decade, this
acute loss of kidney function, previously referred to as
acute renal failure, has been the subject of significant
re-examination, with increased recognition of the importance of relatively small changes in kidney function on
both short- and longer term clinical outcomes.2-6 This
has resulted in the change in terminology from acute
renal failure, for which the focus generally was limited
to the most severe episodes with complete or nearcomplete
loss of kidney function, to the current terminology
of AKI, with increased focus on smaller decrements
in kidney function.