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Neue KDIGO-Leitlinien zur akuten Nierenschädigung

Praktische Handlungsempfehlungen

New KDIGO guidelines on acute kidney injury

Practical recommendations

  • Intensivmedizin
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Zusammenfassung

Die akute Nierenschädigung („acute kidney injury“, AKI) hat bei kritisch kranken Patienten eine hohe Inzidenz und geht mit einer signifikant erhöhten Morbidität und Mortalität im Kurz- und Langzeitverlauf einher. Im Jahr 2012 wurden die KDIGO-Leitlinien (Kidney Disease Improving Global Outcome, KDIGO) publiziert, in denen evidenzbasierte praktische Empfehlungen zur Behandlung von Patienten mit AKI gegeben werden. Der 1. Teil der Leitlinien befasst sich mit der Vereinheitlichung von bisherigen Definitionen sowie der Schweregradeinteilung der AKI. In den weiteren Abschnitten wird unter Berücksichtigung der vorhandenen Evidenz auf Prävention, medikamentöse Therapie und Nierenersatztherapie bei Patienten mit AKI eingegangen. In jedem Abschnitt wird nach Darstellung der aktuellen Datenlage eine klare und gewichtete Behandlungsempfehlung ausgesprochen. Bei Nichtverfügbarkeit von spezifischen medikamentösen Therapien sind die wesentlichen Pfeiler einer effektiven Behandlung die frühe Diagnostik, die Vermeidung von Nephrotoxinen, eine aggressive hämodynamische Optimierung unter strikter Kontrolle des Volumenstatus sowie letztlich eine effektive, aber schonende Nierenersatztherapie.

Abstract

The incidence of acute kidney injury (AKI) in critically ill patients is very high and is associated with an increased morbidity and mortality. In 2012 the Kidney Disease: Improving Global Outcome (KDIGO) guidelines were published in which evidence-based practical recommendations are given for the evaluation and management of patients with AKI. The first section of the KDIGO guidelines deals with the unification of earlier consensus definitions and staging criteria for AKI. The subsequent sections of the guidelines cover the prevention and treatment of AKI as well as the management of renal replacement therapy (RRT) in patients with AKI. In each section the existing evidence is discussed and a specific treatment recommendation is given. The guidelines appreciates that there is insufficient evidence for many of the recommendations. As a specific pharmacological therapy is missing, an early diagnosis, aggressive hemodynamic optimization, tight volume control, and avoidance of nephrotoxic drugs are the only interventions to prevent AKI. If renal replacement therapy is required different modalities are available to provide an effective therapy with a low rate of adverse effects.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Kindgen-Milles erhielt Vortragshonorare und Forschungsunterstützung von Fresenius Medical Care sowie Vortragshonorare von Gambro und Bard. A. Jörres erhielt Vortragshonorare von Fresenius Medical Care und Gambro. S. John erhält Honorare als Mitglied eines „Medical Advisory Boards“ der Firma „Baxter-Gambro Renal“. A. Zarbock: keine Angabe. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer Str. 33, 48149, Münster, Deutschland

    A. Zarbock

  2. Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland

    D. Kindgen-Milles

  3. Medizinische Klinik 4, Universität Erlangen-Nürnberg, Erlangen, Deutschland

    S. John

  4. Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    A. Jörres

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Zarbock, A., John, S., Jörres, A. et al. Neue KDIGO-Leitlinien zur akuten Nierenschädigung. Anaesthesist 63, 578–588 (2014). https://doi.org/10.1007/s00101-014-2344-5

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