KDIGO 2026 Clinical Practice Guideline for Acute Kidney Injury (AKI) and Acute Kidney Disease (AKD) - Public Review Draft - March 2026

Aug 22, 2026

Upload by Xiajie

KDIGO 2026 Clinical Practice Guideline for Acute Kidney Injury (AKI) and Acute Kidney Disease (AKD) provides structured, evidence-informed recommendations for defining, identifying, and classifying AKI/AKD, along with prediction, risk stratification, and diagnostic evaluation. It covers prevention and treatment strategies, including management of drug- and nephrotoxin-associated AKI, and guidance on renal replacement therapy and follow-up care. The March 2026 public review draft is intended for feedback, with content expected to evolve after review.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages499

Reading Time20 h 57 min

AccessFree to download

Summary of recommendation statements and practice points

Chapter 1. AKI and AKD definition, identification, and classification

Chapter 2. AKI prediction, risk stratification, and diagnostic evaluation

Chapter 3. Prevention and treatment of AKI

Chapter 4. Drug- and nephrotoxin-associated AKI

Chapter 5. Renal replacement therapy

Chapter 6. Follow-up care after AKI or AKD

Methods for guideline development

References

KDIGO 2026 CLINICAL PRACTICE GUIDELINE FOR ACUTE KIDNEY INJURY (AKI)AND ACUTE KIDNEY DISEASE (AKD) PUBLIC REVIEW DRAFT MARCH 2026 This is a draft document shared for public review and feedback only. The content of this draft will change based on the feedback received and should not be used for any other purpose beyond its original intent. TABLE OF CONTENTS Tables, figures, and supplementary materials………………………………………………………………….. ii Abbreviations and acronyms………………………………………………………….……………................... x Notice…………………………………………………………………………………..……………………..... xii Work Group membership ………………..……………………………………….....………………………..... xiii Abstract……………………………………….……………………………………..…………………...…….. xiv Summary of recommendation statements and practice points.....……………………………………………… 1 Chapter 1. AKI and AKD definition, identification, and classification……...……………………….………... 35 Chapter 2. AKI prediction, risk stratification, and diagnostic evaluation……………………………………… 66 Chapter 3. Prevention and treatment of AKI………………………………….………………………………... 118 Chapter 4. Durg-and nephrotoxin-associated AKI…………………………………………………………….. 194 Chapter 5. Renal replacement therapy…………………………………………………………………………. 246 Chapter 6. Follow-up care after AKIor AKD………………………………………………………………….. 319 Methods for guideline development…………...………………………………....………………….………..... 354 References……………………………………………………………………………………………................ 378 TABLES Table 1. Criteria for acute kidney injury for children and adults 35 Table 2. Limitations of serum creatinine and urine output for the diagnosis of AKI 36 Table 3. Select kidney biomarkers and reported clinical applications 38 Table 4. Description and characteristics of select AKI biomarkers as of November 2025 39 Table 5. Specific situations where serum cystatin C measurement may be preferable to SCr to detect reduced GFR 47 Table 6. Severity staging system for AKI 50 Table 7. Definitions of transient and persistent AKI 52 Table 8. Causes of AKI requiring specific treatments to protect the kidney 54 Table 9. Criteria for AKD 55 Table 10. Criteria for resolution of AKI and AKD 57 Table 11. Baseline creatinine estimation methods in children 61 Table 12. Criteria for AKI in neonates 62 Table 13. AKI staging criteria in neonates 64 Table 14. Common exposures and susceptibilities for community-and hospital-acquired AKI 67 Table 15. International Society of Nephrology 0by25 study–Clinical risk score for community-acquired acute kidney injury 75 Table 16. Select clinical methods to measure kidney functional reserve 83 Table 17. Select studies identifying albuminuria as a risk factor for AKI 93 Table 18. Urine sediment and associated kidney injury syndromes 105 Table 19. Components of kidney health assessment for risk stratification in high-risk children during acute illness 114 Table 20. Renal angina index scoring 115 Table 21. Vasopressors for management of adults with or at risk of AKI 138 Table 22. Escalation pathway for diuretic therapy in AKI-related volume overload in adults 152 Table 23. Standardized vasoactive therapy in hepatorenal syndrome-associated AKI 165 Table 24. Tropical infections causing AKI 180 Table 25. Common plant and chemical toxins causing AKI 183 Table 26. List of drug/drug classes associated with pseudo-AKI and their possible mechanisms 196 Table 27. Examples of mechanisms and nephrotoxins that cause damage without dysfunction 197 Table 28. Multimodal approach to drug and nephrotoxin stewardship 201 Table 29. Therapeutic drug monitoring for drugs that are potentially nephrotoxic or excreted by the kidney 203 Table 30. Examples of pharmacokinetic and pharmacodynamic drug-drug interactions associated with risk of kidney damage or dysfunction 204 Table 31. Drug-induced crystalline nephropathies 206 Table 32. Description of pharmacist interventions and related outcomes for people with or at risk for AKI in various practice sett

FAQs

What topics does the KDIGO 2026 draft guideline cover for AKI and AKD?

It addresses AKI/AKD definition, identification, and classification; prediction, risk stratification, and diagnostic evaluation; prevention and treatment; drug- and nephrotoxin-associated AKI; renal replacement therapy; and follow-up care after AKI or AKD.

How does the guideline approach AKI diagnosis and risk assessment?

It focuses on prediction, risk stratification, and diagnostic evaluation, including limitations of serum creatinine and urine output for diagnosis and the use of kidney biomarkers and related criteria for staging.

What guidance is provided for treatment and renal replacement therapy?

The draft includes prevention and treatment recommendations, special considerations for drug- and nephrotoxin-associated AKI, and details on renal replacement therapy modalities and relevant clinical management elements.

Aug 22, 2026

Upload by Xiajie