However, not every controlled trial targeting hemodynamics parameters has shown a clinical benefit in preventing AKI. ( 14) showed that trials targeting both supranormal and normal hemodynamic targets decreased the risk of postoperative AKI. Similarly, a meta-analysis investigating perioperative hemodynamic optimization, Brienza et al. Judicious intravenous fluid selection of nonhyperchloremic solutions ( 12) and remote ischemic preconditioning ( 13) showed renoprotective effects, which decreased the incidence of severe AKI (regardless of the need for RRT). Although these studies and others have shown that functional and damage biomarkers with physiologic links to the kidney are useful tools in predicting the risk of progression of early AKI, they were part of observational studies and require additional investigation.Īdditionally, an increasing number of controlled trials has shown efficacy when attempting to prevent severe AKI. ![]() Recently, investigators have shifted their focus beyond simply replacing serum creatinine with a new gold standard and have sought to augment the information provided by serum creatinine and urine output, combining them with biochemical biomarkers, functional assessment of urine-making capacity, or both ( 9– 11). In the past, AKI research has focused on the earlier identification of AKI before the rise in serum creatinine or drop in urine output ( 7, 8). With recent advances in critical care nephrology, including consensus definitions, improved risk stratification, and biomarkers, intensivists and nephrologists are ideally positioned to investigate how best to improve patient outcomes and decrease the severity of renal damage in the golden hours of early AKI ( 4– 6). Although advances in medicine have improved outcomes in these fields, the concept of the golden hour remains loosely applied and increasingly investigated in the setting of AKI. ![]() ![]() Defined as an interval most critical for successful emergency treatment and improved patient outcomes, the golden hour(s) is contingent on the delivery of early and frequently, protocol-driven care. Throughout various fields of scientific investigation, including neonatology and trauma medicine, the idea of the golden hour of treatment has long been debated ( 1– 3).
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