Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup
The 28th Acute Disease Quality Initiative workgroup established the first international consensus definition of sepsis-associated acute kidney injury as AKI occurring within 7 days of sepsis onset, providing graded recommendations for diagnosis and management of a condition strongly tied to adverse outcomes.
Background
Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and is strongly associated with adverse outcomes including chronic kidney disease, cardiovascular events, and death. Its pathophysiology remains incompletely understood, though microcirculatory dysfunction, cellular metabolic reprogramming, and dysregulated inflammatory responses have been implicated in preclinical studies.
Key recommendations
The consensus defines SA-AKI as AKI occurring within 7 days of sepsis onset, diagnosed using KDIGO criteria for AKI and Sepsis-3 criteria for sepsis. Because patients can present with either clinical or subclinical AKI, early identification of those at risk of AKI or of progression to severe and persistent injury is emphasized, including biomarker-based diagnosis and timely initiation of supportive measures that limit further renal insults.
Clinical implications
Specific therapeutic options for SA-AKI remain limited, and management centers on early recognition, treating sepsis, and avoiding additional kidney injury. Clinical trials have evaluated care bundles and extracorporeal techniques as potential approaches, and the workgroup provides graded management recommendations while highlighting priorities for future research, including better biomarkers and trial designs targeting enriched patient populations.
Category
Guidelines
Source
Nature Reviews Nephrology
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