What are the treatment options for Acute Kidney Injury (AKI)?

From the Guidelines

The primary treatment approach for Acute Kidney Injury (AKI) should focus on addressing the underlying cause, preventing further kidney damage, and supporting kidney function until recovery, with initial management including the use of isotonic crystalloids rather than colloids for expansion of intravascular volume, as recommended by the KDIGO clinical practice guideline 1.

Key Treatment Strategies

• Stopping nephrotoxic medications to prevent further kidney damage 1
• Optimizing fluid status through either fluid resuscitation for hypovolemia or diuretics for fluid overload 1
• Maintaining adequate blood pressure to ensure kidney perfusion, with the use of vasopressors in conjunction with fluids in patients with vasomotor shock 1
• Protocol-based management of hemodynamic and oxygenation parameters to prevent development or worsening of AKI in high-risk patients, although this recommendation is based on limited evidence 1

Nutrition and Electrolyte Management

• Achieving a total energy intake of 20-30 kcal/kg/d in patients with any stage of AKI 1
• Administering 0.8-1.0 g/kg/d of protein in noncatabolic AKI patients without need for dialysis, and up to a maximum of 1.7 g/kg/d in patients on continuous renal replacement therapy (CRRT) and in hypercatabolic patients 1
• Providing nutrition preferentially via the enteral route in patients with AKI 1
• Correcting electrolyte imbalances, particularly hyperkalemia, using insulin with glucose, calcium gluconate, sodium bicarbonate, or potassium binders 1

Renal Replacement Therapy

• Initiating renal replacement therapy (dialysis) in severe cases for refractory hyperkalemia, severe acidosis, uremic symptoms, or volume overload unresponsive to diuretics 1

Ongoing Care

• Careful monitoring of kidney function, urine output, electrolytes, and acid-base status to guide therapy and assess recovery 1

From the FDA Drug Label

OVERDOSAGE ... Treatment of overdosage is supportive and consists of replacement of excessive fluid and electrolyte losses. The treatment options for Acute Kidney Injury (AKI) are not directly addressed in the provided drug label. Supportive care is mentioned as a treatment for overdosage, which may include replacement of excessive fluid and electrolyte losses.

• Hemodialysis is mentioned, but only in the context of not accelerating furosemide elimination, not as a treatment for AKI. 2

From the Research

Treatment Options for Acute Kidney Injury (AKI)

The treatment options for AKI include:

• Control of the underlying cause 3
• Achievement and maintenance of euvolemia 3, 4
• Nutritional optimization 3
• Blood glucose control 3
• Pharmacotherapy 3, 5
• Fluid resuscitation or diuresis guided by volume status 3, 4
• Kidney replacement therapy (KRT) 5, 6
• Vasopressor therapy 5

Management of AKI

Management of AKI involves:

• Assessment of the contributing causes of the kidney injury 7
• Assessment of the clinical course including comorbidities 7
• Careful assessment of volume status 7, 4
• Institution of appropriate therapeutic measures designed to reverse or prevent worsening of functional or structural kidney abnormalities 7
• Optimization of volume status and avoidance of nephrotoxic medications 6
• Use of crystalloids over colloids for most patients 6
• Avoidance of hydroxyethyl starches 6
• Attention to overall fluid balance to prevent volume overload 6

Referral to a Nephrology Subspecialist

Emergent referral to a nephrology subspecialist is recommended for:

• Patients with stage 2 or 3 AKI 3
• Patients with stage 1 AKI and a concomitant, decompensated condition 3
• Patients with unclear etiology of AKI 3
• Urgent referral should be considered if the injury does not improve with treatment or if glomerulonephritis is suspected 3