What factors make Acute Kidney Injury (AKI) less likely?

From the Guidelines

Maintaining optimal fluid status, specifically euvolaemia, is critical in reducing the incidence of Acute Kidney Injury (AKI). This is supported by the most recent and highest quality study, which emphasizes the importance of fluid management in preventing AKI 1. Key strategies to prevent AKI include:

• Maintaining adequate hydration, especially during illness or when taking medications that can affect kidney function
• Avoiding nephrotoxic medications when possible, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics
• Using the lowest effective dose for the shortest duration if these medications are necessary
• Implementing pre-procedure hydration protocols and minimizing contrast volume for patients undergoing procedures with contrast media
• Managing underlying conditions like diabetes, hypertension, and heart failure through medication adherence and lifestyle modifications
• Temporarily stopping medications that affect kidney perfusion, such as ACE inhibitors, ARBs, and diuretics, during acute illness
• Regularly monitoring kidney function through blood tests, especially for those at high risk, including elderly patients and those with chronic kidney disease

Optimizing periprocedural hydration therapy has been shown to reduce the risk of postprocedural AKI, with studies demonstrating the effectiveness of isotonic hydration therapy and LVEDP-guided hydration therapy 1. Contrast minimization and optimization of periprocedural hydration therapy are the only strategies proven to reduce the risk of postprocedural AKI. Additionally, radial artery access has been associated with a lower risk of postprocedural AKI. By prioritizing these strategies, healthcare providers can significantly reduce the incidence of AKI and improve patient outcomes.

From the FDA Drug Label

As with other aminoglycosides, gentamicin injection is potentially nephrotoxic. The risk of nephrotoxicity is greater in patients with impaired renal function and in those who receive high dosage of prolonged therapy Other factors which may increase patient risk of toxicity are advanced age and dehydration The concurrent use of gentamicin with potent diuretics, such as ethacrynic acid or furosemide, should be avoided, since certain diuretics by themselves may cause ototoxicity.

The factors that make Acute Kidney Injury (AKI) less likely include:

• Normal renal function 2
• Adequate hydration (implied by the fact that dehydration increases the risk of toxicity) 2
• Avoidance of high doses and prolonged therapy 2
• Avoidance of concurrent use with potent diuretics 2
• Avoidance of concurrent use with other potentially nephrotoxic drugs 2
• Monitoring of renal function and adjustment of dosage as needed 2 2

From the Research

Factors Reducing Acute Kidney Injury (AKI) Risk

The following factors can make Acute Kidney Injury (AKI) less likely:

• Oral hydration: Studies have shown that oral hydration can be as effective as intravenous hydration in preventing contrast-induced AKI in patients with normal kidney function or stage 1-2 chronic kidney disease 3, 4.
• Intravenous hydration: Intravenous hydration with isotonic saline has been found to reduce the development of CI-AKI in patients with non-ST segment elevation myocardial infarction (NSTEMI) at low risk for CI-AKI 5.
• Forced diuresis with matched hydration: The use of automated forced diuresis with matched saline infusion is being investigated as a potential therapeutic tool to reduce the occurrence of AKI in patients undergoing transcatheter aortic valve implantation (TAVI) 6.
• Adequate post-procedural oral hydration: Adequate oral hydration, defined as a ratio of oral hydration volume to weight over 12 mL/kg within 24 hours after primary percutaneous coronary intervention (PCI), has been found to be an independent protective factor associated with CI-AKI 4.

Patient Characteristics

Certain patient characteristics can also influence the risk of AKI:

• Older age: Older age has been found to be an independent risk factor for developing CI-AKI 5, 7.
• Diabetes: Diabetes has been found to be a predictor of CA-AKI and patients with diabetes are at an increased risk of morbidity and mortality following peripheral vascular interventions (PVI) 7.
• Severity of chronic kidney disease (CKD): The severity of CKD has been found to be a predictor of CA-AKI, with patients having more severe CKD being at higher risk 7.