Acute kidney injury (AKI) is an increasingly common clinical problem faced by nephrologists and intensivists, as well as general physicians and surgeons. AKI is associated with adverse outcomes both in the short and long term with chronic kidney disease (CKD) being increasingly recognised as a common sequela of AKI. In an analysis of 19,982 consecutive admissions in a single centre in Boston, USA, AKI was significantly associated with mortality, length of stay and healthcare cost [1]. Elevations in serum creatinine were common, affecting up to 13% of patients, and even relatively modest elevations in serum creatinine were associated adverse outcomes–a rise in serum creatinine of≥ 0.5 mg/dl (44 µmol/l) was associated with 6.5-fold increase in the risk of death. The inadequacies of AKI management were highlighted by a recent UK government survey where the care of AKI was deemed inadequate in 33% of cases, with poor recognition of risk factors such as sepsis and hypovolaemia [2]. The pattern and burden of AKI appears to be particularly significant in developing countries [3] and therefore the recently published Kidney Disease Improving Global Guidelines (KDIGO) Clinical Practice Guidelines for Acute Kidney Injury provides a welcome and timely synthesis of the evidence base to support the management of AKI [4].

As in previous guidelines, KDIGO utilised a grading system with level 1 being rated a ‘strong recommendation’, implying that most patients ‘should’receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’evidence base. The overall strength and quality of the supporting evidence is summarised in table 1.