The Japanese clinical practice guideline for acute kidney injury 2016

Abstract

Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention is necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.

Guideline on the use of iodinated contrast media in patients with kidney disease 2018

“…According to the KDIGO AKI guidelines, the diagnostic criteria of AKI are an increase in SCr by ≥ 0.3 mg/dL within 48 h or a urine volume reduction to < 0.5 mL/kg/h over 6 h. According to KDIGO policy, CIN is a form of AKI and should be evaluated on the same basis. Although the criteria for diagnosing AKI by KDIGO are also supported by the AKI clinical practice guideline 2016 in Japan (AKI guideline 2016) [3], the diagnostic criteria for CIN were not included in AKI guideline 2016. According to the ESUR guideline published in 2018, as a definition of CIN, an increase in SCr by ≥ 0.3 mg/dL from the baseline level within 48-72 h after administration of the contrast medium or a 1.5-1.9-fold increase.…”

“…The prevalence of acute kidney injury (AKI) is rapidly increasing in the United States at a rate of about 5 times over 20 years due to an aging population and increased incidences of CKD and diabetes mellitus. Since the KDIGO AKI diagnostic criteria were published in 2012 [1], they have been used as the international standard, and the Japanese guidelines for AKI published in 2016 support the KDIGO criteria [3]. AKI represents a broad disease spectrum that develops in the context of various disease states.…”

“…The CIN guideline 2012 did not recommend the administration of loop diuretics, since no study had specified CIN patients as subjects and no significant effect of loop diuretics was observed even in RCTs that targeted AKI patients. Furthermore, the AKI guideline 2016 [3] stated that loop diuretics should not be administered as a treatment for AKI except for the purpose of correcting fluid overload. After the onset of AKI, renal conditions are no longer suitable for loop diuretics, and their use may increase the risk of AKI progression by decreasing the effective circulating plasma volume.…”

“…Clinical trials examining the effect of hydration therapy on patients after the onset of CIN were not found. The AKI guideline 2016 [3] recommends considering the possibility of renal AKI that is resistant to hydration therapy and has a high in-hospital mortality rate if the renal function of AKI patients does not react to an infusion load within a few days. Similarly, hydration therapy should be performed only in patients with reduced renal blood flow in CIN.…”

“…In a crossover study, Lauschke et al [292] demonstrated that while pharmacologically low-dose dopamine reduced the renal resistive index (RI) in healthy subjects, it increased the RI and reduced renal blood flow in AKI patients. The AKI guideline 2016 [3] also recommended against using low-dose dopamine for preventive and therapeutic purposes in AKI. Thus, administration of low-dose dopamine after the onset of CIN is not recommended, because it does not inhibit the progression of renal dysfunction.…”