Prevention of acute kidney injury and protection of renal function in the intensive care unit

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P < 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

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Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

10.1101/2020.08.16.20175992 ◽

2020 ◽

Author(s):

Nina J Caplin ◽

Olga Zhdanova ◽

Manish Tandon ◽

Nathan Thompson ◽

Dhwanil Patel ◽

...

Keyword(s):

Intensive Care Unit ◽

New York ◽

Acute Kidney Injury ◽

New York City ◽

Renal Function ◽

Intensive Care ◽

Peritoneal Dialysis ◽

Kidney Injury ◽

Bellevue Hospital ◽

Kidney Replacement Therapy

The COVID-19 pandemic created an unprecedented strain on hospitals in New York City. Although practitioners focused on the pulmonary devastation, resources for the provision of dialysis proved to be more constrained. To deal with these shortfalls, NYC Health and Hospitals/Bellevue, NYU Brooklyn, NYU Medical Center and the New York Harbor VA Healthcare System, put together a plan to offset the anticipated increased needs for kidney replacement therapy. Prior to the pandemic, peritoneal dialysis was not used for acute kidney injury at Bellevue Hospital. We were able to rapidly establish an acute peritoneal dialysis program at Bellevue Hospital for acute kidney injury patients in the intensive care unit. A dedicated surgery team was assembled to work with the nephrologists for bedside placement of the peritoneal dialysis catheters. A multi-disciplinary team was trained by the lead nephrologist to deliver peritoneal dialysis in the intensive care unit. Between April 8, 2020 and May 8, 2020, 39 peritoneal dialysis catheters were placed at Bellevue Hospital. 38 patients were successfully started on peritoneal dialysis. As of June 10, 2020, 16 patients recovered renal function. One end stage kidney disease patient was converted to peritoneal dialysis and was discharged. One catheter was poorly functioning, and the patient was changed to hemodialysis before recovering renal function. There were no episodes of peritonitis and nine incidents of minor leaking, which resolved. Some patients received successful peritoneal dialysis while being ventilated in the prone position. In summary, despite severe shortages of staff, supplies and dialysis machines during the COVID-19 pandemic, we were able to rapidly implement a de novo peritoneal dialysis program which enabled provision of adequate kidney replacement therapy to all admitted patients who needed it. Our experience is a model for the use of acute peritoneal dialysis in crisis situations.

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Erratum to: Prevention of acute kidney injury and protection of renal function in the intensive care unit

Intensive Care Medicine ◽

10.1007/s00134-010-1780-1 ◽

2010 ◽

Vol 36 (4) ◽

pp. 727-727

Author(s):

Michael Joannidis ◽

Wilfred Druml ◽

Lui G. Forni ◽

A. B. Johan Groeneveld ◽

Patrick Honore ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Kidney Injury

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Acute Kidney Injury and COVID-19: A Picture from an Intensive Care Unit

Blood Purification ◽

10.1159/000513153 ◽

2021 ◽

pp. 1-5

Author(s):

Francesco Alessandri ◽

Valentina Pistolesi ◽

Chiara Manganelli ◽

Franco Ruberto ◽

Giancarlo Ceccarelli ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Respiratory Failure ◽

Kidney Injury ◽

Icu Mortality ◽

Icu Stay ◽

Renal Function Recovery ◽

Tertiary Teaching

Introduction: Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care unit (ICU) for severe respiratory failure. The aim is to evaluate the rate of AKI, defined according to Kidney Disease: Improving Global Outcome guidelines, in a series of critical COVID-19 patients admitted to the ICU of a single tertiary teaching hospital. Methods: From April to May 2020, all consecutive critically ill COVID-19 patients admitted to the ICU who did not meet exclusion criteria (length of ICU stay <48 h, ESRD requiring dialysis, and patients still hospitalized in ICU at the time of data analysis) were enrolled in this study. Patients were stratified according to the highest AKI stage attained during ICU stay. Results: Sixty-one patients were included in the analysis. AKI was observed in 35/61 patients (57.4%): 25/35 episodes (71.4%) were observed within the first 7 days. AKI was classified as follows: 17.1% stage 1, 25.7% stage 2, and 57.2% stage 3. Fourteen out of 20 stage-3 patients required continuous renal replacement therapy (CRRT), mostly related to persistent oliguria. The overall ICU mortality was 68.9%, and it was higher in patients developing AKI if compared to no-AKI patients (p = 0.006). Renal function recovery of any grade was observed in 14 out of 35 AKI patients (40%). Among patients undergoing CRRT, 13 patients were still dialysis dependent at the time of death. Conclusion: In critical COVID-19 patients, ICU mortality is particularly high, especially in patients developing AKI. An accurate monitoring of renal function in early phases of respiratory failure should be ensured in order to timely apply any strategy aimed at limiting renal complications during ICU stay.

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Geriatric patients with known acute kidney injury and normal renal function at the time of admittance to the intensive care unit/assessment of RRT requirement and mortality: retrospective case-control study

Wiener klinische Wochenschrift ◽

10.1007/s00508-014-0684-4 ◽

2015 ◽

Vol 127 (7-8) ◽

pp. 290-296

Author(s):

Fatmanur Karakose ◽

Muhammet Emin Akkoyunlu ◽

Reha Erkoc ◽

Abdullah Kansu ◽

Mehmet Bayram ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Geriatric Patients ◽

Case Control Study ◽

Kidney Injury ◽

Case Control ◽

Retrospective Case ◽

Control Study

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Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Intensive Care Medicine ◽

10.1007/s00134-017-4832-y ◽

2017 ◽

Vol 43 (6) ◽

pp. 730-749 ◽

Cited By ~ 117

Author(s):

M. Joannidis ◽

W. Druml ◽

L. G. Forni ◽

A. B. J. Groeneveld ◽

P. M. Honore ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Kidney Injury

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The Role of Dexmedetomidine for the Prevention of Acute Kidney Injury in Critical Care

EMJ Nephrology ◽

10.33590/emjnephrol/21-00087 ◽

2021 ◽

pp. 97-106

Author(s):

Gion Ruegg ◽

Nora Luethi ◽

Luca Cioccari

Keyword(s):

Experimental Data ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Clinical Trials ◽

Renal Function ◽

Critical Care ◽

Intensive Care ◽

Kidney Injury ◽

Ischaemia Reperfusion

Acute kidney injury (AKI) occurs in up to 50% of patients admitted to the intensive care unit and is associated with increased mortality. Currently, there is no effective pharmacotherapy for prevention or treatment of AKI. In animal models of sepsis and ischaemia-reperfusion, α2-agonists like dexmedetomidine (DEX) exhibit anti-inflammatory properties and experimental data indicate a potential protective effect of DEX on renal function. However, clinical trials have yielded inconsistent results in critically ill patients. This review discusses the pathophysiological mechanisms involved in AKI, the renal effects of DEX in various intensive care unit-related conditions, and summarises the available literature addressing the use of DEX for the prevention of AKI.

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Rhabdomyolysis-associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis

10.21203/rs.3.rs-40084/v1 ◽

2020 ◽

Author(s):

Decai Zhu ◽

Wenyan Li ◽

Jiawen Zhang ◽

Junsheng Tong ◽

Wenyuan Xie ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Clinical Characteristics ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Icu Transfer ◽

Icu Treatment

Abstract Background: Rhabdomyolysis (RM) associated acute kidney injury (AKI) is the most common systemic complication of RM. The present study aimed to assess the clinical characteristics and risk factors for intensive care unit (ICU) transfer for patients with RM-associated AKI.Methods: We included all patients who were age ≥ 18 years old with a diagnosis of RM from September 2012 to October 2018 and divided them into RM-associated AKI group and RM without AKI group. The primary outcome was transferring to ICU treatment. Regression analysis was performed to identify factors associated with ICU treatment and recovery of renal function.Results: Among the 149 patients with RM, 68 (45.6%) developed AKI. The percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% versus 12.3%, P < 0.002). Additionally, patients with AKI had higher percentage of undergoing dialysis (19.1% versus 2.5%, P < 0.01), all-cause mortality (13.2% versus 1.2%, P < 0.01), cost of hospitalization [10.8 1,000 yuan, IQR (5.5, 3.5) versus 5.9 1,000 yuan, IQR 5.9 (3.6, 9.9), P = 0.03], as well as longer length of hospital stay [8.0 (5.0, 14.0)] versus [6.0 (4.0, 11.0)], P = 0.02). Moreover, most patients with AKI achieved complete recovery (77.9%) at discharge. After adjusting for potential risk factors, RM-associated AKI remained an independent risk factor for ICU transfer (OR = 3.0, 95% CI, 1.11–8.3, P = 0.03). However, ICU transfer was not associated with recovery of renal function (OR = 0.88, 95% CI, 0.22–3.57, P = 0.856).Conclusion: RM leaded to AKI in most patients. RM-associated AKI could cause worse clinical outcome and predict ICU transfer for patients with RM.

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COVID-19 and acute kidney injury; a case report

Journal of Renal Injury Prevention ◽

10.34172/jrip.2020.26 ◽

2020 ◽

Vol 9 (3) ◽

pp. e26-e26

Author(s):

Hassan Ghobadi ◽

Mohammad Ebrahimi Kalan ◽

Jafar Mohammad-Shahi ◽

Ziyad Ben Taleb ◽

Abbas Ebrahimi Kalan ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Case Report ◽

Kidney Injury ◽

Prior History ◽

Normal Value ◽

Definitive Evidence ◽

History Of

Although there is no definitive evidence that coronavirus disease 2019 (COVID-19) affects the kidneys adversely, amongst those who develop severe COVID-19 infection and require hospitalization, acute kidney injury (AKI) was reported. Here, we report the clinical outcome associated with AKI in a 32-year-old man with confirmed COVID-19 infection with no prior history of renal malfunction. The AKI was identified during intensive care unit (ICU) course with the median creatinine and blood urea nitrogen values of 3.1 mg/dL (normal value: 0.6-1.2 mg/dL) and 145 mg/dL (normal value:15-45 mg/dL), respectively. Renal function of patients hospitalized with COVID-19 infection needs to be monitored regularly to intervene as early as possible and to prevent the development of AKI and further kidney complications.

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