REFERENCE BOOK
KDIGO Clinical Practice Guideline for Acute Kidney Injury
Research Recommendations
Research recommendations
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Randomized trials of isotonic crystalloid vs. colloid therapy for intravascular volume expansion to prevent or treat AKI should be conducted in a variety of settings (critical illness, high-risk surgery, sepsis), including patient subsets. In particular, colloids may improve efficiency of fluid resuscitation but some (starch) also carry some concerns regarding effects on the kidneys. If colloid results in less volume overload, it may lead to improved outcomes.
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Comparisons of specific solutions, with specific electrolyte composition or colloid type, for effectiveness in preventing AKI should be conducted. Specifically, there is a need to examine physiologic electrolyte solutions vs. saline.
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Studies are needed that compare different types of vasopressors for prevention and treatment of AKI in hemodynamically unstable patients. Some evidence suggests that certain vasopressors may preserve renal function better than others (e.g., vasopressin analogues vs. catecholamines) and studies are needed to compare them in this setting.
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The choice of a target mean arterial perfusion pressure range of 65–90mm Hg as a component of resuscitation (perhaps in the context of age, chronic blood pressure, or other comorbidities) also needs further study.
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The specific components of goal-directed therapy that accrue benefits for patients at risk for AKI need to be determined. Is it the timing of protocolized hemodynamic management that is beneficial: prophylactically in highrisk surgical patients, or early in the course of severe sepsis? In contrast to the benefits of prophylactic or EGDT, protocolized use of inotropes to normalize mixed venous oxygen saturation or supranormalize oxygen delivery in ‘‘late’’ critical illness did not result in decreased AKI128 or improved outcomes.128,129 Alternatively, is it attention to hemodynamic monitoring, the protocol itself that standardizes supportive care to achieve the stated goals, or a single or combination of the multiple possible interventions that improves outcome? Thus, further research is required to determine the specific components of goaldirected therapy that accrue benefits for patients at risk for AKI, if such benefits actually occur.
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