KDIGO Clinical Practice Guideline for Acute Kidney Injury

Introduction and Methodology
AKI Definition
Prevention and Treatment of AKI
Contrast-induced AKI
Dialysis Interventions for Treatment of AKI
Organization and Acknowledgements

Summary of Recommendation Statements

Section 2: AKI Definition

  • 2.1.1:AKI is defined as any of the following (Not Graded):
    • Increase in SCr by ≥ 0.3 mg/dl ( ≥ 26.5 µmol/l) within 48 hours; or
    • Increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
    • Urine volume < 0.5 ml/kg/h for 6 hours.
  • 2.1.2:AKI is staged for severity according to the following criteria (Table 2). (Not Graded)
Table 2 | Staging of AKI
Stage Serum creatinine Urine output
1 1.5–1.9 times baseline
≥ 0.3 mg/dl ( ≥ 26.5 µmol/l) increase
< 0.5 ml/kg/h for 6–12 hours
2 2.0–2.9 times baseline < 0.5 ml/kg/h for ≥ 12 hours
3 3.0 times baseline
Increase in serum creatinine to ≥ 4.0 mg/dl ( ≥ 353.6 µmol/l)
Initiation of renal replacement therapy
OR, In patients < 18 years, decrease in eGFR to < 35 ml/min per 1.73 m2
< 0.3 ml/kg/h for ≥ 24 hours
Anuria for ≥ 12 hours
  • 2.1.3: The cause of AKI should be determined whenever possible. (Not Graded)
  • 2.2.1: We recommend that patients be stratified for risk of AKI according to their susceptibilities and exposures. (1B)
  • 2.2.2: Manage patients according to their susceptibilities and exposures to reduce the risk of AKI (see relevant guideline sections). (Not Graded)
  • 2.2.3: Test patients at increased risk for AKI with measurements of SCr and urine output to detect AKI. (Not Graded) Individualize frequency and duration of monitoring based on patient risk and clinical course. (Not Graded)
  • 2.3.1: Evaluate patients with AKI promptly to determine the cause, with special attention to reversible causes. (Not Graded)
  • 2.3.2: Monitor patients with AKI with measurements of SCr and urine output to stage the severity, according to Recommendation 2.1.2. (Not Graded)
  • 2.3.3: Manage patients with AKI according to the stage (see Figure 4) and cause. (Not Graded)
  • 2.3.4: Evaluate patients 3 months after AKI for resolution, new onset, or worsening of pre-existing CKD. (Not Graded)
    • If patients have CKD, manage these patients as detailed in the KDOQI CKD Guideline (Guidelines 7–15). (Not Graded)
    • If patients do not have CKD, consider them to be at increased risk for CKD and care for them as detailed in the KDOQI CKD Guideline 3 for patients at increased risk for CKD. (Not Graded)
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