Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis.

Reduced renal clearance has the surprising and counterintuitive effect of being an effective treatment for AKI.

In this perspective, Dr Lakhmir S. Chawla suggests a hypothesis describing why the uremic milieu is kidney protective and proposes a clinical trial of ‘permissive azotemia’ to improve renal recovery and long-term renal outcomes in critically ill patients with severe AKI.

Hear more about the explanation of this hypothesis in the following podcast, organised by the ESICM AKI Section.


Lakhmir S. CHAWLA. Chief Medical Officer, Silver Creek Pharmaceuticals. Recipient of the International Vicenza Award for Critical Care Nephrology.

Eric HOSTE. UZ Gent (BE). AKI Section Representative, ESICM Social Media & Digital Content Committee.

Marc ROMAIN. Hadassah Medical Center, Jerusalem (IL).

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