KDIGO Upcoming guidelines:
This was a special reports lecture from the KDIGO (Kidney disease: improving global outcomes) group on their upcoming guidelines for AKI:
These guidelines should be published probably in early 2011.
Dr. Norbert Lameire from Belgium presented and chairs the AKI committee.
The known RIFLE and AKIN definitions of AKI --> should be changed to one single definition of AKI.
KDIGO defines AKI defined as any one of the following
A. Increase in SCre by 0.3 mg/dL with in 48 hour
B. Or increase SCr by 1.5 fold above known baseline which occurred in past 7 days
C. Or Urine volume of less 0.5 ml/kg/h for 6 hour
KDIGO also recommending a new concept – called AKD (acute kidney disease)
If patients recovery back to normal serum creatinine, This “presumed” recovered AKI should be be called AKD.
Patients with AKI often go on to develop CKD (due to ultra-structural renal pathologic changes) despite “normalized” Serum Creatinine à hence that patient’s diagnosis is AKD.
Other recommendations in their upcoming guidelines includes:
Contrast AKI – use only iso-osmolar or low osmolar contrast at lowest volume
Use isotonic Saline or NaHCO3 isotonic in at risk patients
Recommend N-Acetyl Cysteine (Mucomyst) together with IV Isotonic fluids, but There is NO role for N-Acetyl Cysteine ALONE.
And a couple of recommendations on dialysis in AKI from the guidelines:
Suggest CRRT only for patients with Acute brain injury versus Intermittant HD (Grade 2B recommendation)
Dialysis Dosing recommendations:
Weekly Kt/V of 3.9/week in intermittent HD
Or CRRT dose of 20 – 25 cc/min effluent volume as optimal dosing
Remember, guidelines are not the “Gospel” and nor should they be considered the Gold “standard if care”.
Stay tuned for full published guidelines on AKI in early 2011.
Also, there will be upcoming KDIGO guidelines on Blood pressure control in CKD coming in late 2011 or 2012. It will be interesting to see now these differ from the JNC and KDOQI guidelines!
By Stanley Crittenden, MD