|
Prevention and Early Identification of AKI after major surgery
| |
|
Obtain a serum creatinine before surgery
|
30 (100)
|
|
Use isotonic crystalloids to expand intravascular volume during surgery
|
29 (97)
|
|
Monitor serum creatinine daily to identify AKI after surgery
|
26 (87)
|
|
Monitor urine output daily to identify AKI after surgery
|
29 (97)
|
|
Monitor fluid balance daily after surgery
|
26 (87)
|
|
In the absence of volume overload, provide maintenance IV fluids after surgery
|
30 (100)
|
|
Administer aminoglycosides using single daily dosing in patients at risk of AKI
|
25 (83)
|
|
Discontinue non-steroidal anti-inflammatory drugs prior to surgery
|
28 (93)
|
|
Avoid repeated exposure to iodinated contrast after surgery
|
26 (87)
|
|
Monitor serum creatinine after prescribing a nephrotoxic drug
|
29 (97)
|
|
Avoid hydroxy-ethyl starch for volume expansion in patients with reduced kidney function‡
|
26 (87)
|
|
Flag patients at high risk of perioperative acute kidney injury in the medical record
|
28 (93)
|
|
Early Management of AKI After major surgery:
| |
|
Perform a urinalysis for investigation of the cause of AKI
|
29 (97)
|
|
Determine the severity of AKI by monitoring serum creatinine daily after the onset of AKI
|
30 (100)
|
|
Determine the severity of AKI by monitoring urine output daily after the onset of AKI
|
30 (100)
|
|
Monitor fluid balance daily after the onset of AKI
|
30 (100)
|
|
Monitor for acid–base disturbances after the onset of AKI
|
29 (97)
|
|
Monitor for hyperkalemia after the onset of AKI
|
30 (100)
|
|
Provide intravenous crystalloids to optimize hemodynamic status and restore effective circulating volume and blood pressure in patients with AKI and signs of volume depletion
|
30 (100)
|
|
Avoid non-steroidal anti-inflammatory drugs after the onset of AKI
|
30 (100)
|
|
Avoid aminoglycosides after the onset of AKI unless no other antibiotics are available
|
27 (90)
|
|
Provide vasopressors/inotropes to patients with AKI and vasomotor shock that does not respond to IV fluids
|
29 (97)
|
|
Review current medications to identify those that are nephrotoxic or require dose adjustment after the onset of AKI
|
30 (100)
|
|
Avoid diuretics in the absence of volume overload after the onset of AKI
|
30 (100)
|
|
Recommendations for Prevention of Contrast-induced AKI:
| |
|
Obtain a serum creatinine before a contrast imaging procedure
|
27 (90)
|
|
Use isotonic crystalloids for prevention in patients at high risk of CI-AKI
|
30 (100)
|
|
Use the lowest possible dose of iso-osmolar or low-osmolar iodinated contrast media in patients at high risk of CI-AKI
|
30 (100)
|
|
Withhold NSAIDs and diuretics before contrast administration
|
27 (90)
|
|
Use an imaging test that doesn’t require iodinated contrast administration in patients with AKI
|
28 (93)
|
|
Criteria for Nephrologist Consultation:
| |
|
An unclear etiology or cause other than pre-renal or acute tubular necrosis is suspected
|
30 (100)
|
|
Hyperkalemia refractory to medical therapy
|
29 (97)
|
|
AKI that is unresponsive to treatment or worsening
|
28 (93)
|
|
Respiratory compromise due to volume overload in anuric patients
|
28 (93)
|
|
Severe AKI (i.e., KDIGO Stage 3, 3-fold increase in serum creatinine or increase in Scr > 350 μmol/L)
|
26 (87)
|
|
Signs or symptoms of uremia
|
29 (97)
|
|
A patient that may require renal replacement therapy
|
27 (90)
|
|
Criteria for Critical Care Consultation
| |
|
AKI with hemodynamic instability not responding to fluid resuscitation
|
30 (100)
|
|
Need for renal replacement therapy in hemodynamically unstable patient
|
28 (93)
|
|
Need for intubation or ventilatory support
|
30 (100)
|
|
Need for vasopressors or inotropes
|
30 (100)
|
