KDIGO Clinical Practice Guideline for Acute Kidney Injury
Rationale for a guideline on AKI

Rationale for a guideline on AKI

AKI is a global problem and occurs in the community, in the hospital where it is common on medical, surgical, pediatric, and oncology wards, and in ICUs. Irrespective of its nature, AKI is a predictor of immediate and long-term adverse outcomes. AKI is more prevalent in (and a significant risk factor for) patients with chronic kidney disease (CKD). Individuals with CKD are especially susceptible to AKI which, in turn, may act as a promoter of progression of the underlying CKD. The burden of AKI may be most significant in developing countries^34,35 with limited resources for the care of these patients once the disease progresses to kidney failure necessitating RRT. Addressing the unique circumstances and needs of developing countries, especially in the detection of AKI in its early and potentially reversible stages to prevent its progression to kidney failure requiring dialysis, is of paramount importance.

Research over the past decade has identified numerous preventable risk factors for AKI and the potential of improving their management and outcomes. Unfortunately, these are not widely known and are variably practiced worldwide, resulting in lost opportunities to improve the care and outcomes of patients with AKI. Importantly, there is no unifying approach to the diagnosis and care of these patients. There is a worldwide need to recognize, detect, and intervene to circumvent the need for dialysis and to improve outcomes of AKI. The difficulties and disadvantages associated with an increasing variation in management and treatment of diseases that were amplified in the years after the Second World War, led in 1989 to the creation in the USA of the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality). This agency was created to provide objective, science-based information to improve decision making in health-care delivery. A major contribution of this agency was the establishment of a systematic process for developing evidence-based guidelines. It is now well accepted that rigorously developed, evidencebased guidelines, when implemented, have improved quality, cost, variability, and outcomes.^36,37

Realizing that there is an increasing prevalence of acute (and chronic) kidney disease worldwide and that the complications and problems of patients with kidney disease are universal, Kidney Disease: Improving Global Outcomes (KDIGO), a nonprofit foundation, was established in 2003 ‘‘to improve the care and outcomes of kidney disease patients worldwide through promoting coordination, collaboration, and integration of initiatives to develop and implement clinical practice guidelines’’.³⁸

Besides developing guidelines on a number of other important areas of nephrology, the Board of Directors of KDIGO quickly realized that there is room for improving international cooperation in the development, dissemination, and implementation of clinical practice guidelines in the field of AKI. At its meeting in December of 2006, the KDIGO Board of Directors determined that the topic of AKI meets the criteria for developing clinical practice guidelines.

These criteria were formulated as follows:

• AKI is common.
• AKI imposes a heavy burden of illness (morbidity andmortality).
• The cost per person of managing AKI is high.
• AKI is amenable to early detection and potential prevention.
• There is considerable variability in practice to prevent, diagnose, treat, and achieve outcomes of AKI.
• Clinical practice guidelines in the field have the potential to reduce variations, improve outcomes, and reduce costs.
• Formal guidelines do not exist on this topic.