Acute Kidney Injury and Chronic Kidney Disease

Chronic kidney disease (CKD) is a potent risk factor for acute kidney injury (AKI) and a modifier for the relationship between AKI and adverse outcome, while AKI increases the risk of de novo CKD and is an accelerator for the progression of underlying CKD. When patients with CKD develop dialysis-requiring AKI, available data suggest that the recovery of kidney function is less likely than in patients without CKD. Patients with AKI were more likely to develop CKD compared with matched control patients without AKI. For CKD patients at high risk for developing AKI, preventive measures for AKI include adequate fluid repletion in those with hypovolemia, avoidance of hypotension by providing inotropic support as needed, and readjustment of nephrotoxic medications based on close monitoring of renal function and drug levels, if available. For CKD patients developing AKI, the basic principles of general management include specific treatment of the underlying cause, fluid management, electrolyte management, adjustment of drug dosing, nutritional support, renal replacement therapy, and specific pharmacologic therapies.