Authors are listed in alphabetic order. *Denotes group facilitator.
Acute Dialysis Quality Initiative
4th International Consensus Conference
Preventing/Minimizing iatrogenic acute kidney injury
Iatrogenic acute kidney injury can be defined as acute kidney injury (AKI) that is directly or indirectly due
to medical (therapeutic or diagnostic) interventions. This definition does not imply that iatrogenic AKI is
always preventable. Indeed, sometimes the need for the medical intervention outweighs the risk of causing
kidney dysfunction. On the other hand, in many circumstances iatrogenic renal damage can be prevented or
at least minimized. In hospitalized patients reported incidences of iatrogenic AKI vary between 1 and 3%
[1,2]. Although therapeutic interventions, such as certain surgical procedures (cardiopulmonary bypass,
aortic cross clamping) or intensive care treatments (mechanical ventilation) may also contribute to renal
impairment, drug nephrotoxicity is the main cause of iatrogenic kidney dysfunction. 20-60% of all cases of
AKI are considered drug-related [3,4]. The exact incidence of nephrotoxicity associated with a particular
drug is difficult to determine because of the lack of uniformity in defining the criteria for renal dysfunction
and the poor literature that is mostly limited to clinical series and case reports, often restricted to patients
with risk factors.
What are the main factors contributing to iatrogenic kidney injury and how can
their impact be minimized?
Iatrogenic AKI is mainly due to insufficient knowledge of and/or attention to: (a) the presence of risk
factors for nephrotoxicity, (b) alternative therapies for drugs with potential nephrotoxicity, (c) appropriate
drug dosing adapted to altered kinetics, (d) the correct assessment of kidney function before and at
appropriate intervals during treatment with the aim of early recognition of kidney injury and (e) preventive