Critical Care Nephrology
and Acute Kidney Injury
Introduction to Critical Care Nephrology and Acute
Kidney Injury
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Kathleen D. Liu1 and Paul M. Palevsky2
WnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 05/19/2023
CJASN 17: 570–571, 2022. doi: https://doi.org/10.2215/CJN.01400222
Over the past several decades, the acuity of hospital-
ized patients has increased, as has the percentage of
time that nephrologists spend caring for patients in
intensive care units. This includes both the care of
patients with CKD or dialysis-dependent kidney fail-
ure who are predisposed to the development of criti-
cal illness in the setting of sepsis, cardiovascular
disease, and postsurgical management as well as the
management of patients with various etiologies of
AKI. This increasing overlap between nephrology and
critical care is manifested by an increasing number of
nephrologists who have chosen to obtain dual training
in nephrology and critical care medicine, and nephrol-
ogy training programs developing dedicated critical
care nephrology tracks (1). However, even for those
who are not dual trained, it is increasingly important
that nephrologists remain abreast of the continuing
advances in critical care medicine as they relate to the
care of patients with kidney disease, as well as specific
aspects of kidney disease that may arise in the inten-
sive care unit.
Nearly a quarter of a century ago, the American Soci-
ety of Nephrology began holding an annual critical care
nephrology update, which has consistently been one of
the best attended precourses during Kidney Week. With
this issue, CJASN begins a new monthly educational
series focused on critical care nephrology. This series will
be written by distinguished authors with expertise span-
ning nephrology, critical care, and associated specialties.
It is our goal that this series, which will be published
over the next 2 years, will provide updates on broad
aspects of critical care nephrology that will be clinically
relevant to seasoned clinicians as well as serve as a
primer on topics that are important to trainees.
Starting with the current issue, the series will begin
with six articles that form a primer of critical care medi-
cine for the nephrologists including management of
respiratory failure; an update on shock, volume man-
agement, and hemodynamic monitoring; a review of
the pathogenesis and management of sepsis; an over-
view of forms of nonrenal extracorporeal life support;
and an overview of general medical management of the
critically ill patient. The selection of these topics reflects
areas where there has been significant growth in
evidence-based management (e.g., respiratory failure
and sepsis), along with areas where the rapid
570 Copyright © 2022 by the American Society of Nephrology
development of new technologies is highly relevant to 1
Divisions of
nephrologists (e.g., nonrenal extracorporeal life sup-
Nephrology and Critical
port). The second portion of the series will focus on Care Medicine,
multiple aspects of AKI, ranging from epidemiology Departments of
and diagnostic criteria to reviews of diverse etiologies Medicine and
Anesthesia, University
of AKI that are often encountered in the intensive care
of California, San
unit including prerenal states, abdominal compartment Francisco, San
syndrome, sepsis, contrast administration, nephrotoxic Francisco, California
2
medications, postsurgical patients, cancer, liver disease, Renal-Electrolyte
Division, University of
and cardiorenal syndrome. This will be followed by a
Pittsburgh School of
review of critical fluid and electrolyte issues and a series Medicine and Kidney
of reviews serving as a primer on the management of Medicine Section, VA
kidney replacement therapy in the intensive care unit. Pittsburgh Healthcare
This latter series will cover topics related to timing of System, Pittsburgh,
Pennsylvania
initiation, selection of modality, and volume manage-
ment as well as reviews of the technical aspects of man- Correspondence:
agement of intermittent hemodialysis, continuous and Dr. Kathleen D. Liu,
prolonged intermittent kidney replacement therapies, UCSF – Medicine, Box
and acute peritoneal dialysis. Finally, the series will con- 0532, San Francisco,
CA 94143. Email:
clude with several miscellaneous topics, including med- Kathleen.Liu@ucsf.edu
ication management in the critically ill patient with AKI
and the management of poisonings and intoxications.
We hope that you find this series useful in your day-to-
day care of patients in the intensive care unit.
Disclosures
K.D. Liu reports consultancy agreements with AM
Pharma, Biomerieux, BOA Medical, and Seastar Medical;
stock in Amgen; serving on the Editorial Boards of American
Journal of Kidney Diseases, American Journal of Respiratory and
Critical Care Medicine, and CJASN; serving as a scientific advi-
sor or member of the NKF Scientific Advisory Board and
American Thoracic Society; and other interests or relation-
ships with UpToDate.
P.M. Palevsky reports employment with the United States
Department of Veterans Affairs and VA Pittsburgh Health-
care System; consultancy agreements with Janssen Research
& Development, LLC; and serving as President of the
National Kidney Foundation and being a member of the
National Kidney Foundation Scientific Advisory Board, a
member of the Renal Physicians Association Quality, Safety
and Accountability Committee, Chair of the Quality Insights
Renal Network 4 Medical Review Board, Section Editor,
Renal Failure of UpToDate; and a member of the Editorial
Board of Journal of Intensive Care Medicine.
www.cjasn.org Vol 17 April, 2022
 CJASN 17: 570–571, April, 2022 Critical Care Nephrology and Acute Kidney Injury, Liu and Palevsky 571

Funding Reference
None. 1. Sanghavi SF, Campbell KN: Careers in critical care nephrology:
Opportunities and challenges. Clin J Am Soc Nephrol 15: 1198–
1200, 2020
Author Contributions
K.D. Liu and P.M. Palevsky wrote the original draft and reviewed Published online ahead of print. Publication date available at
and edited the manuscript. www.cjasn.org.
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