KDIGO Clinical Practice Guideline for Acute Kidney Injury
Introduction

Chapter 2.2: Risk assessment

The kidney is a fairly robust organ that can tolerate exposure to several insults without suffering significant structural or functional change. For this reason, any acute change in kidney function often indicates severe systemic derangement and predicts a poor prognosis. Risk for AKI is increased by exposure to factors that cause AKI or the presence of factors that increase susceptibility to AKI. Factors that determine susceptibility of the kidneys to injury include dehydration, certain demographic characteristics and genetic predispositions, acute and chronic comorbidities, and treatments. It is the interaction between susceptibility and the type and extent of exposure to insults that determines the risk of occurrence of AKI.

Understanding individual ‘‘risk factors’’ may help in preventing AKI. This is particularly gratifying in the hospital setting, where the patient’s susceptibility can be assessed before certain exposures as surgery or administration of potentially nephrotoxic agents. Accordingly, some susceptibility factors may be modified, and contemplated exposures avoided or tailored to reduce the risk of AKI.

Risk assessment in community-acquired AKI is different from hospital-acquired AKI, for two main reasons: i) Available evidence on risk factors is largely derived from hospital data and extrapolation to the community setting is questionable. ii) The opportunity to intervene, prior to exposure, is quite limited. Most patients are seen only after having suffered an exposure (trauma, infection, poisonous plant, or animal). However, there is still room to assess such patients, albeit after exposure, in order to identify those who are more likely to develop AKI, thereby requiring closer monitoring and general supportive measures. It may also be helpful to identify such patients in order to avoid additional injury. A more complete discussion of the approach to identification and management of risk for AKI is provided in Appendices C and D.