Zhang J, et al. - In this retrospective study utilizing prospectively gathered data of patients admitted to a multi-disciplinary ICU in a single tertiary care centre in the UK between January 2014 and December 2016, researchers investigated factors independently related to the development of new acute kidney injury (AKI) during early stay in the ICU. They also explored the risk factors for non-recovery of AKI. There were 2,525 patients without AKI on admission. Among these, the incidence of early ICU-acquired AKI was estimated to be 33.2%. Factors that were independently related to the new development of AKI were: body mass index, Sequential Organ Failure Assessment score on admission, chronic kidney disease (CKD) and cumulative fluid balance (FB). Those without renal recovery experienced significantly higher hospital mortality. Findings revealed that mechanical ventilation, diuretic use, AKI stage III, CKD, net FB on first day of AKI and cumulative FB 48 h later were independently related to non-recovery with cumulative fluid balance having a U-shape link. In the ICU, early development of AKI was common. Patients who did not recover renal function had the highest mortality. Strong risk factors for AKI non-recovery were extreme negative and positive FB.