Table 3.

Potential interventions to modify kidney–lung interactions

Therapeutic category	Intervention type	Patient population/number of patients/trial type	Results	Level of evidence
Ventilation strategies	Spontaneous breathing during APRV	Acute lung injury 12 patients [OT]	Improved renal blood flow and GFR with spontaneous breathing vs. controlled ventilation [76]	C
	Lung protective ventilation	ARDS 861 patients [RCT]	Less days with renal failure (defined as sCr ≥ 2 mg/dL) in the lung protective ventilation group [73]	B
	Neuromuscular blockade and lung-protective ventilation	Early ARDS 340 patients [RCT]	Significantly more ventilator-free days (p = 0.04) and more days without renal failure (20.5 ± 10.1 vs. 18.1 ± 11.6 days; p = 0.05) [79]	B
		1006 patients [RCT]	No effect on mortality and kidney failure free days by day 28 in another trial [80]	B
	Prone ventilation	ARDS 16 patients [OT]	No effect on renal blood flow index, glomerular filtration rate index, filtration fraction, urine volume, fractional sodium excretion, and osmolar and free water clearances [77]	C
Anti-inflammatories	Glucocorticoids ± mineralocorticoid	ARDS 91 patients [RCT]	Improvement in extra-pulmonary organ function, including a trend towards less AKI by day 7 (18% vs. 37%; p = 0.06) No effect on RRT [85]	C
Fluids	Albumin and diuretics	ARDS 40 [RCT]/37 [RCT] patients	Administration of Albumin together with diuretics improved oxygenation and facilitated negative fluid balance in hypoproteinaemic ARDS patients [38, 39]	C
	Conservative fluid management	ARDS 1000 patients [RCT]	Trend towards reduced need for RRT with fluid restrictive strategy [36]	C
		2124 patients [RCT]	Less AKI with fluid restrictive strategy after correction for fluid balance [40]	C
	Furosemide and conservative fluid management	ARDS 1000 [RCT]	Trend towards reduced need for RRT (10% vs. 14%; p = 0.06) [36]	C
		ARDS + AKI 306 [SG] patients	Reduced mortality in patients with AKI and ARDS [37]	C

APRV airway pressure release ventilation, ARDS acute respiratory distress syndrome, AKI acute kidney injury, RRT renal replacement therapy, OT observational trial, RCT randomised controlled trial, SG subgroup analysis, GFR glomerular filtration rate, sCR serum creatinine