AKI Prevention Points

AKI Prevention

Prevention of macrocirculation for prerenal AKI

• IV crystalloid fluids (NS, LRs) to achieve and maintain euvolemia

• Avoid hypotension — if MAP <65mmHg, use vasopressors (e.g. norepinephrine)

• Treat vascular occlusion/thrombus

Prevention of microcirculation for prerenal AKI involves which drugs?

• ACEis, ARBs, ARNIs

• NSAIDs

• Calcineurin inhibitors (e.g. tacrolimus, cyclosporine)

Which type of AKI involves NSAID considerations to prevent it?

Prerenal

NSAID-based AKI prevention strategy

• If needed, start NSAID low dose and titrate slowly up

Which type of AKI involves ACEi/ARB/ARNi considerations to prevent it?

Prerenal

ACEi/ARB/ARNi-based AKI prevention strategy

• Start low dose and titrate slowly up

• Monitor SCr and K

Calcineurin inhibitor-based AKI prevention strategy

• Use lowest effective dose

• Therapeutic drug monitoring to track serum levels

Which type of AKI involves aminoglycoside considerations to prevent it?

Intrinsic

For which drug should the strategy of…

• Use inhaled formulation for pulmonary infections

…be used to prevent AKI secondary to it?

Aminoglycosides

For which drug should the strategy of…

• Monitor trough levels

…be used to prevent AKI secondary to it?

Aminoglycosides

For which drug should the strategy of…

• Extended interval dosing

…be used to prevent AKI secondary to it?

Aminoglycosides

Which type of AKI involves amphotericin B considerations to prevent it?

Intrinsic

For which drug should the strategy of…

• Use lipid-based (liposomal) formulation

…be used to prevent AKI secondary to it?

Amphotericin B

For which drug should the strategy of…

• 1L of IV NS prior to each administration

…be used to prevent AKI secondary to it?

Amphotericin B

Which type of AKI involves cisplastin considerations to prevent it?

Intrinsic

For which drug should the strategy of…

• IV NS prior to and after each administration

…be used to prevent AKI secondary to it?

Cisplatin

For which drug should the strategy of…

• Amifostine IV prior to administration

…be used to prevent AKI secondary to it?

Cisplatin

Which type of AKI involves contrast dye considerations to prevent it?

Intrinsic

For which drug should the strategy of…

• Avoid high-osmolar preparations if possible

…be used to prevent AKI secondary to it?

Contrast dye

For which drug should the strategy of…

• NS or sodium bicarb IV infusions before and after administration

…be used to prevent AKI secondary to it?

Contrast dye (3-12 hours prior, 6-24 hours after)

Which type of AKI involves anticholinergic considerations to prevent it?

Postrenal

Drug-induced crystal nephropathy or calculi is a form of which type of AKI?

Postrenal

Which type of AKI involves acyclovir considerations to prevent it?

Postrenal — specifically drug-induced crystal nephropathy or calculi

For which drug should the strategy of…

• Ensure adequate hydration

…be used to prevent AKI secondary to it?

Acyclovir

Recurrent nephrolithiasis is a form of which type of AKI?

Postrenal

Recurrent nephrolithiasis prevention strategies

• Thiazides

• Potassium citrate

• Allopurinol

Thiazides are a prevention strategy of which type of AKI?

Postrenal — specifically recurrent nephrolithiasis

Potassium citrate is a prevention strategy of which type of AKI?

Postrenal — specifically recurrent nephrolithiasis

What is potassium citrate?

Urinary alkalinizing agent — reduces the precipitation which forms kidney stones

Allopurinol is a prevention strategy of which type of AKI?

Postrenal — specifically recurrent nephrolithiasis