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Abstract Background and aim Acute kidney injury (AKI) is becoming increasingly prevalent among hospitalized patients and carries a poor prognosis. While new biomarkers show promise in identifying early stages of AKI, accurately predicting severe outcomes such as the need for kidney replacement therapy (KRT) or death remains a challenge. However, blood gas analyses (BGA) can be used to diagnose life-threatening complications associated with AKI. The objective of this study was to assess the role of BGA as a biomarker panel in both emerging and established cases of AKI. Methods Retrospective observational study examining subjects with newly developed acute kidney injury (AKI). The study will document venous and arterial pH, pCO2, and actual bicarbonate levels upon hospital admission and at the onset of AKI. The primary endpoints include in-hospital mortality, the need for kidney replacement therapy (KRT), and the recovery of kidney function (ROKF). Results A total of 202 individuals were included in the study. Three variables were found to be independent predictors of in-hospital survival: admission arterial pH, arterial pH at acute kidney injury (AKI) onset, and arterial pCO2 at AKI onset. Additionally, venous pCO2 at AKI onset was identified as an independent predictor for the need of kidney replacement therapy (KRT). Conclusions Our study suggests that blood gas analysis may have a potential role in predicting severe outcome variables in acute kidney injury (AKI). The associated costs are minimal.

Background and aim Acute kidney injury (AKI) affects a significant number of patients and the prognosis for this condition remains poor. The aim of this study was to assess adherence to KDIGO clinical practice guidelines and identify areas for improvement. Methods For this retrospective study, data were extracted from the medical database of the University Hospital Brandenburg, for patients who had been diagnosed with AKI from January to March 2021. Implementation rates of eight KDIGO AKI therapeutic measures were analyzed in relation to several AKI severity/risk categories. Results Data from 200 patients were included in the study. Three specific measures were commonly implemented: hyperglycemia control (100%), volume therapy (82%), and fluid balance management (65%). Nephrotoxic medications were discontinued in 51% patients, while iodinated contrast media was used in 35% patients. Patients with an increased risk of complications, such as those requiring ICU therapy or with sepsis, received these measures more frequently. Conclusions While some 2012 KDIGO recommended measures were implemented for a substantial number of affected individuals, others were not. Our study highlights the need for improvement in the quality of care for patients with AKI.

Objective Iodinated contrast medium is potentially nephrotoxic in susceptible individuals. The aim of this retrospective observational study was to determine the impact of hospital-wide implementation of a guideline to prevent contrast-associated acute kidney injury (CA-AKI) on quality of care and outcomes. Methods A hospital-wide guideline for management of patients known to be at risk of CA-AKI was implemented in April 2019. All patients who underwent coronary angiography at our institution between November 2018 and March 2019 (period 1, before introduction of the guideline) and between August and December 2019 (period 2, after introduction of the guideline) were enrolled. Results In total, 561 patients were enrolled for period 1 and 578 for period 2. CA-AKI was impossible to diagnose in many patients because of missing post-procedure creatinine control data. Preventive measures were initiated more often in period 2 than in period 1 and in older patients than in younger patients. Preventive measures were not initiated in at least 50% of patients at risk of CA-AKI despite implementation of the guideline. Conclusions Management of patients at known risk of CA-AKI remains inadequate at our institution even after introduction of a guideline. Physicians should receive organized training in acute kidney injury.

Background: Acute kidney injury (AKI) affects increasing numbers of hospitalized patients; the prognosis remains poor. The diagnosis is still based on the 2012 published KDIGO criteria. Numerous new AKI biomarkers have been identified in recent years; they either reflect impaired excretory function or structural damage. The majority of markers are useful for AKI recognition under certain circumstances. Fewer data are available on the role of biomarkers in the prediction of in-hospital survival and renal recovery post-AKI. The current article is intended to provide information about these two aspects. Summary: The following databases were screened: PubMed, Web of Science, Cochrane Library, Scopus. The period lasted from 2000 until 2022. The following terms were applied: “AKI” AND “biomarker” AND “survival” OR “mortality” OR “recovery of kidney function” OR “renal recovery” OR “kidney recovery”. The following terms were used for additional literature search: “TIMP-2” AND “IGFBP7” and “RNA biomarker” AND “hematology”. Regarding mortality, exclusively those studies were selected that addressed the in-hospital mortality. Nine (9) studies were identified that evaluated biomarker-based prediction of in-hospital mortality and/or of recovery of kidney function (ROKF). A homogenous definition of ROKF is however missing yet. Currently, some biomarkers, measured early during the course of the disease, are associated with increased mortality risk and/or with a higher chance of renal recovery. Key Messages: The literature provides only a few biomarker-related studies that address the issues of mortality and recovery. The definition of ROKF needs to be homogenized.