ICS State of the Art Meeting 2015

1. Acute Kidney Injury: Does it kill
you?
Rinaldo Bellomo
ANZIC RC
Melbourne, Australia

2. Why are we asking the question?
• People with ESRF die when dialysis withdrawn
• Before the advent of dialysis severe AKI was
almost universally fatal
• However…….
• We now have ICUs
• We have RRT
• We have lots of therapeutic interventions that
make it reasonable to ask
• “ Do people die of AKI or with AKI?”

21. OK – So AKI may kill you – but what can we do to stop it?
How about the magical healing powers of
Early Goal Directed Therapy?

25. Ooops…all a waste of time, resources, cannulation, money

49. Conclusions
• AKI may kill you but we can’t be sure
• If it does, it would be nice to prevent it
• The most common therapy to prevent it is vigorous
fluid administration
• However, most evidence suggest that such therapy
may actually be homicidal in AKI
• Playing with blood pressure may help but maybe only
when adjusted to aim toward pre-morbid BP targets
• The real everyday problem with AKI is not that it may
or may not kill patients but that, at a deeper level,
we have no idea of what we are doing