Intensive Care Med 2025 Jul 15; doi: 10.1007/s00134-025-08015-8.

Preventing acute kidney injury and its longer-term impact in the critically ill.

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Acute kidney injury (AKI) is a heterogeneous syndrome that not only affects short-term morbidity and mortality but also influences long-term outcomes. AKI is part of acute kidney disease (AKD) that encompasses a range of different conditions and is characterized by a kidney dysfunction lasting 90 days or less after which time the term chronic kidney disease (CKD) applies. AKD may result in irreversible loss of nephrons and may lead to CKD. In this narrative review, an update on different aspects of AKI in critically ill patients will be provided. We discuss biomarkers for early diagnosis of AKI, sub-clinical AKI, as well as AKI-AKD-CKD transition. In addition, various strategies to prevent the development of AKI, including the application of amino acids, remote-ischemic preconditioning, hemoadsorption, and a kidney prevention strategy, will be discussed. Finally, the choice of adequate endpoints for AKI prevention trials will be addressed."Take home message".AKI and even subclinical AKI impact short- and long-term outcome and therefore, prevention of kidney injury is of utmost importance. As several strategies have been proven to be effective in preventing the development of AKI, these therapies should be implemented in daily practice to improve patient outcomes.

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