Italian AKI Guidelines: The Best of the KDIGO and ADQI Results

phrology, the Italian Society of Anesthesiology and Intensive Care and the Italian Society of Intensive Care have initiated an effort to translate and update the KDIGO guidelines for regional use in Italy [2] , applying the following criteria: (1) The main body of guidelines has been taken from the KDIGO, thus making an accurate translation and keeping the level of evidence and recommendation for every point as it originally was. (2) A thorough search of the literature has been made adding the references and the results of all papers published in each field of AKI since the KDIGO publication until December 2014. (3) The comments to the KDIGO guidelines made by different organizations including the ERA-EDTA, the ASN, Canadian Society of Nephrology, the NHS and others have been included for the benefit of the reader to make him/her aware of the different scientific points of view. (4) A specific effort has been made to comment on the real applicability of the guidelines to the Italian practice, given the availability of medications, devices etc., in that region. (5) A special chapter has been dedicated to nomenclature and terminology in the attempt to unify and harmonize all definitions and abbreviations. (6) Last but not least, a special commentary has been dedicated to the guidelines to guidelines, which is a series Continuous search for strong evidence supporting the many procedures and interventions in critical care nephrology has led to development of guidelines and recommendations [1] . These documents are intended to support the clinicians in their practice improving outcomes and reducing medical errors and complications. Clinical practice guidelines sometimes are difficult to prepare or to implement due to the scanty evidence in specific areas. There are high costs involved in preparing accurate and solid guidelines, while, on the other side, the full application of guidelines is sometimes difficult if not impossible in the real clinical arena. Acute kidney injury (AKI) makes no exception to these concerns. The evidence supporting diagnostic and therapeutic measures applied in daily practice is in most cases insufficient to clearly establish what is beneficial for the patient and what is futile. Thus, the lack of solid evidence and the limitation of the available resources lead to the sort of clinical practice that is a mixture of anecdotes, expert opinions and sometimes biased visions. In this setting, a person could become skeptic and paralyzed, or he may be pushed to go for the best possible approach. The KDIGO guidelines for AKI have represented a step forward, but they have been continuously challenged by new studies and new publications making it necessary to consider not only the guidelines but also all the related commentaries [1] . In this view, The Italian Society of NePublished online: August 28, 2015