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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 Oct 19
Acute kidney injury in liver transplant candidates: a position paper on behalf of the LIVER INTENSIVE CARE GROUP of EUROPE
Paolo ANGELI 1, Dimitri BEZINOVER 2, Gianni BIANCOFIORE 3, Anja BIENHOLZ 4, James FINDLAY 5, Catherine PAUGAM BURTZ 6 , Koen REYNTJENS 7, Tetsuro SAKAI 8, Fuat H. SANER 9, Dana TOMESCU 10, Gebhard WAGENER 11, Emmanuel WEISS 6 ✉
1 Department of Medicine, Hepatology Unit, University School of Medicine, Padova, Italy; 2 Department of Anesthesiology, Penn State Hershey Medical Center, Hershey, PA, USA; 3 Department of Transplant Anesthesia and Critical Care, Azienda Ospedaliera-Universitaria Pisa, Italy; 4 Department of Nephrology, University Duisburg-Essen, Germany; 5 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA; 6 Department of anesthesia and Critical care, APHP Hopital Beaujon, Paris and University Paris Diderot-Paris 7, PARIS, France; 7 Department of Anesthesia, University Medical Center, Groningen, University of Groningen, Netherlands; 8 Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 9 Department of General, Visceral, and Transplant Surgery, University Duisburg-Essen, Germany; 10 Department of Anesthesiology and Critical Care, Fundeni Clinical Institute, Bucharest, Romania; 11 Gebhard Wagener, Department of Anesthesiology, University of Columbia , New York, NY, USA
Acute kidney injury (AKI) is associated with high perioperative mortality. A series of AKI research breakthroughs are worth mentioning. First, in 2003, serum and urine biomarkers specific to AKI were identified. These biomarkers have contributed to early detection, prevention, and treatment of AKI. In 2004, AKI severity was defined with the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria, which was developed by the International Consensus Conference Workgroup of the Acute Dialysis Quality Initiative. In 2007, the definition was further refined by the AKI network classification, and in 2012 Kidney Disease Improving Global Outcomes (KDIGO) standardized the RIFLE criteria into AKI stages I to III. Finally, a definition of AKI specifically for patients with end-stage liver disease (ESLD) was established by the International Club of Ascites (ICA) in 2015. Overall, these definitions and standardized criteria provide a foundation for systematic management of patients with AKI. Another important challenge over the last 20 years in the management of AKI is establishing the optimum timing to initiate renal replacement therapy (RRT). Previous evaluations did not support the use of RRT at the early stage of kidney dysfunction. Although a number of retrospective studies published in the last 10 to 15 years support using RRT at an early stage for patients with AKI, the exact indication for RRT remains unclear.