Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup.
In critically ill patients, multi-organ dysfunction is frequent and often involves the lungs and kidneys, due for example to Acute Kidney Injury (AKI) or Acute Respiratory Distress Syndrome (ARDS). Extracorporeal organ support (e.g. Invasive Mechanical Ventilation (IMV), Renal Replacement Therapy (RRT) and Extra Corporeal Membrane Oxygenation (ECMO)) is frequently required in the disease-management of these patients.
Still, many gaps in knowledge exist regarding the interactions between lung and kidney in critically ill patients. To summarise current evidence and give recommendations for clinical practice and on potential future research topics, a consensus conference on the spectrum of lung-kidney interactions was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018.
The following topics are presented in the final conference report: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with Acute Kidney Injury and/or kidney dysfunction among patients with acute respiratory failure/Acute Respiratory Distress Syndrome.
The ADQI 21 Conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung–kidney interactions to improve care processes and outcomes in critical illness.
TAKE HOME MESSAGE
- The aim of the XXI. ADQI conference was to elaborate on the organ crosstalk between lung and kidney in critically ill patients. Both clinical and research recommendations provide the basis for further optimisation of care of affected patients.
This article review was prepared and submitted by Sebastian J Klein, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria, on behalf of the ESICM AKI Section and the Journal Review Club.
1) Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup. Joannidis, M., Forni, L.G., Klein, S.J. et al. Intensive Care Med (2019).
2) Lunge-Nieren-Interaktionen bei kritisch Kranken. Interactions between lung and kidney in the critically ill. Klein, S.J., Husain-Syed, F., Karagiannidis, C. et al. Med Klin Intensivmed Notfmed (2018) 113: 448.