From the Guidelines
The initial approach to treating acute kidney injury (AKI) following blood transfusion should focus on supportive care, addressing the underlying cause, and considering renal replacement therapy (RRT) if necessary, as recommended by the most recent guidelines 1. The treatment of AKI following blood transfusion involves several key steps:
- Discontinue the blood transfusion immediately if it's still ongoing.
- Ensure adequate hydration with intravenous fluids, typically isotonic crystalloids like normal saline at 1-2 mL/kg/hour, adjusted based on volume status, as suggested by previous guidelines 1.
- Monitor fluid balance carefully to avoid volume overload and maintain hemodynamic stability, ensuring adequate renal perfusion, targeting a mean arterial pressure of at least 65 mmHg.
- Avoid nephrotoxic medications including NSAIDs, aminoglycosides, and contrast agents.
- Implement strict monitoring of intake and output, daily weights, and regular laboratory assessments including BUN, creatinine, and electrolytes.
- Diuretics like furosemide (20-40 mg IV) may be used cautiously if volume overload develops, but not to treat the AKI itself, as recommended by the KDIGO guideline 1.
- If the AKI is due to hemolytic transfusion reaction, corticosteroids (methylprednisolone 1-2 mg/kg/day) may be considered.
- For severe cases with metabolic derangements, oliguria unresponsive to fluid resuscitation, or uremic symptoms, RRT may be necessary, with the choice of modality tailored to the patient's clinical status, as discussed in the 2020 Kidney International article 1.
- The delivery of RRT should aim to reach the goals of electrolyte, acid-base, solute, and fluid balance for each specific patient, with a Kt/V of at least 1.2 per treatment 3 times a week for intermittent or extended RRT, and an effluent volume of 20-25 ml/kg per hour for continuous RRT.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Approach to Treating Acute Kidney Injury (AKI) Following Blood Transfusion
- The initial approach to treating AKI following blood transfusion involves a thorough history and physical examination to categorize the underlying cause as prerenal, intrinsic renal, or postrenal 2.
- Laboratory work-up, medication adjustment, identification and reversal of underlying cause, and referral to appropriate specialty care are also essential in the initial evaluation and management of AKI 2.
- Continuous renal replacement therapy (CRRT) may be used to provide renal support for critically ill patients with AKI, particularly those who are hemodynamically unstable 3.
Treatment Options for AKI
- CRRT techniques, such as continuous venovenous hemofiltration, continuous venovenous hemodialysis, and continuous venovenous hemodiafiltration, may be used to manage AKI 3.
- Furosemide administration has been associated with improved short-term survival and recovery of renal function in critically ill patients with AKI, especially in those with AKI stage 2-3 degree 4.
- Tidal peritoneal dialysis (TPD) has been shown to have better outcomes compared to continuous renal replacement therapy (CRRT) in the treatment of critically ill patients with AKI 5.