Acute kidney injury: summary of NICE guidance

Acute kidney injury is seen in about 15% of adults admitted to hospital in developed countries,1 with elderly people being particularly affected. The definition of acute kidney injury is based on monitoring serum creatinine levels, with or without urine output (see tables 1⇓ and 2⇓ for examples of definitions for adults and children (the “Further information” box on bmj.com discusses controversies in the definition)). In a recent large NHS audit of severe (stage 3) acute kidney injury, mortality across hospitals was consistent at about 30-40% (personal communication, James Medcalf). As acute kidney injury often occurs in people under the care of healthcare professionals other than nephrologists, awareness of the condition needs to be raised among all healthcare professionals, especially those seeing sick or older patients. It is estimated that raising awareness and delivery of optimal care could save about 12 000 lives and £150m in England each year.4 This article summarises the most recent recommendations on acute kidney injury for adults, young people, and children from the National Institute for Health and Care Excellence (NICE).5 View this table: Table 1 Initial detection and staging of acute kidney injury in adults according to Kidney Disease: Improving Global Outcomes (KDIGO) Group2 View this table: Table 2 Initial detection and staging of acute kidney injury in children according to pRIFLE (paediatric RIFLE) definition3 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Identifying acute kidney injury in adults with acute illness