Advances in clinical research on acute kidney injury, 2025–2026: A narrative review

Acute kidney injury (AKI) is a common clinical syndrome in the intensive care unit (ICU) that not only substantially increases in-hospital mortality but is also closely associated with the development and progression of chronic kidney disease, posing a serious threat to patient health. Recently, driven by advances in cutting-edge technologies such as liquid biopsy, multi-omics, and artificial intelligence, clinical research on AKI has achieved important breakthroughs. This narrative review systematically searched PubMed, Web of Science, EMBASE, and Cochrane Library databases for clinical studies published between January 2025 and August 2026, with particular emphasis on ICU-related AKI, especially surgery- and sepsis-associated AKI. The review focuses on three major aspects: early identification and risk stratification, optimization of prevention and treatment strategies, and individualized implementation and management of kidney replacement therapy. Between 2025 and 2026, clinical research on AKI yielded several important advances. These include the identification of multi-omics-based liquid-biopsy biomarkers and the development of causal deep-learning models enabling more accurate risk prediction. Terlipressin treatment improved reversal rates in selected patients with hepatorenal syndrome. However, multiple high-quality perioperative randomized controlled trials investigating blood pressure targets, artificial intelligence–assisted hemodynamic optimization, albumin infusion, and other interventions yielded negative or even harmful results, suggesting that hemodynamic interventions may have reached a benefit ceiling within current treatment paradigms. Meanwhile, the timing of kidney replacement therapy initiation, technical considerations, and weaning strategies have become increasingly customized. This review aims to provide the latest evidence-based information to guide clinical practice while identifying gaps in the current evidence and highlighting priorities for future research.