From the Guidelines
Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are two distinct conditions that affect the kidneys, but they have different causes, symptoms, and treatment approaches 1.
Key Differences
- Definition: AKI is diagnosed by a 50% or greater sustained increase in serum creatinine over a short period of time, whereas CKD is defined as an abnormality of kidney structure or function, present for >3 months, with health consequences 1.
- Causes: AKI can be caused by various factors such as nephrotoxic medications, contrast agents, and decreased renal blood flow, whereas CKD is often caused by chronic conditions such as hypertension and diabetes 1.
- Symptoms: AKI can present with oliguria, fluid overload, and electrolyte imbalances, whereas CKD may be asymptomatic in its early stages, but can progress to end-stage renal disease if left untreated 1.
Treatment Approaches
- AKI: Treatment involves discontinuing nephrotoxic medications, initiating fluid resuscitation, and considering medications like fenoldopam or dopamine to improve renal perfusion 1.
- CKD: Management involves lifestyle modifications, such as a low-protein diet, regular exercise, and smoking cessation, as well as medications like ACE inhibitors or ARBs to slow disease progression 1.
Monitoring and Individualization
It is essential to monitor kidney function regularly in both conditions, with serum creatinine and urine output measurements, to adjust treatment plans accordingly 1. In general, it is crucial to approach these conditions with caution and to individualize treatment based on the patient's specific needs and medical history 1.
From the Research
Definition and Difference
- Acute Kidney Injury (AKI) is characterized by a sudden decline in or loss of kidney function, whereas Chronic Kidney Disease (CKD) is a long-term condition where the kidneys gradually lose their function over time 2.
- AKI can lead to CKD, and CKD is a major risk factor for the development of new AKI 3, 4.
- The distinction between AKI and CKD may be artificial, and consideration should be given to the integrated clinical syndrome of diminished GFR, with acute and chronic stages 4.
Acute Kidney Disease (AKD)
- AKD is defined as the post-AKI status of acute or subacute kidney damage/dysfunction manifested by persistence of AKI beyond 7 to 90 days after the initial AKI diagnosis 5.
- AKD can occur without a rapid onset usually seen in AKI, such as when kidney dysfunction slowly evolves 6.
- The incidence of AKD is observed in approximately 25% of AKI survivors 5.
Relationship between AKI and CKD
- AKI can cause end-stage renal disease (ESRD) directly, and increase the risk of developing incident CKD and worsening of underlying CKD 4.
- Severity, duration, and frequency of AKI appear to be important predictors of poor patient outcomes 4.
- CKD is an important risk factor for the development and ascertainment of AKI 3, 4.
- Experimental data support the clinical observations and the bidirectional nature of the relationships between AKI and CKD 3, 4.