Can we prevent acute kidney injury?

Crit Care Med. 2008 Apr;36(4 Suppl):S166-71. doi: 10.1097/CCM.0b013e318168c74a.


Objective: To review the literature on prevention of acute kidney injury (AKI).

Data source: MEDLINE- and PubMed-based review of literature published from 1965 to 2007.

Conclusions: AKI is very common among critically ill patients. Even mild forms of AKI have significant attributable mortality. Hence, it is imperative that every effort to prevent AKI be made in clinical practice. However, there are very few interventions that have been shown to consistently prevent AKI. Measures such as adequate hydration, maintenance of adequate circulating blood volume and mean arterial pressure, and avoidance of nephrotoxins are still the mainstay of prevention. Loop diuretics and "renal-dose" dopamine have been clearly shown not to prevent AKI and may, in fact, do harm. Among the remaining pharmacologic options, N-acetylcysteine has the strongest evidence in prevention of AKI. Fenoldopam and theophylline need further investigation before being used to prevent septic AKI and contrast nephropathy, respectively. The role of prophylactic dialysis in preventing contrast nephropathy needs to be investigated further.

Publication types

  • Review

MeSH terms

  • Acetylcysteine / therapeutic use*
  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / prevention & control*
  • Aminoglycosides / administration & dosage
  • Aminoglycosides / adverse effects
  • Amphotericin B / administration & dosage
  • Amphotericin B / adverse effects
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / adverse effects
  • Chemistry, Pharmaceutical
  • Contrast Media / adverse effects
  • Critical Care
  • Dehydration / complications
  • Dehydration / prevention & control*
  • Free Radical Scavengers / therapeutic use*
  • Humans
  • Risk Factors
  • Sodium Potassium Chloride Symporter Inhibitors / adverse effects


  • Aminoglycosides
  • Antifungal Agents
  • Contrast Media
  • Free Radical Scavengers
  • Sodium Potassium Chloride Symporter Inhibitors
  • Amphotericin B
  • Acetylcysteine