Clinical consequences of acute kidney injury.

Acute kidney injury (AKI) can no longer be considered a surrogate marker for severity of illness. Recent epidemiologic data demonstrate the association of AKI and mortality. Even small decreases of kidney function are associated with increased mortality. Several clinical consequences of AKI may explain the association of AKI and mortality. Decreased free water clearance leading to volume overload contributes to morbidity and mortality, but also to deterioration of kidney function. Acid-base disorders and electrolyte abnormalities interfere with normal functioning of many processes in the body. Critically ill patients have an increased prevalence of infection. Infection and antimicrobial therapy can be the cause of AKI, but infection can also be a consequence of AKI. Finally, inadequate antimicrobial dosing probably plays an important role in the morbidity and mortality of AKI. These findings have led to a paradigm shift: patients die because of AKI rather than with AKI.