Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy

Background/Aims: Polymyxin-B (PMX) treatment has been reported to decrease mortality in patients with septic shock and acute kidney injury (AKI). In this study, we aimed to evaluate whether extended sessions of PMX (Ext-PMX) immobilized fiber column hemoperfusion ameliorate clinical outcomes in patients complicated with septic shock and AKI without surgical control. Methods: Twenty-two patients with nonsurgical septic shock and AKI who received PMX were included. They were divided according to the duration of PMX treatment: Ext-PMX and standard PMX (Std-PMX). Results: The mean blood pressure increased and inotrope requirement decreased within 24 h after PMX initiation. The median value of predicted mortality was 52.5%, and the 28-day mortalities in the Ext-PMX and Std-PMX groups were 44.4 and 75% respectively. Renal replacement therapy (RRT) was also initiated in 17 patients, and renal insufficiency was recovered. Conclusion: Ext-PMX combined with RRT improved clinical outcomes in patients with nonsurgical septic shock and AKI.

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Acute Kidney Injury in Patients with Sepsis and Septic Shock: Risk Factors and Clinical Outcomes

Yonsei Medical Journal ◽

10.3349/ymj.2013.54.4.965 ◽

2013 ◽

Vol 54 (4) ◽

pp. 965 ◽

Cited By ~ 34

Author(s):

Sang Heon Suh ◽

Chang Seong Kim ◽

Joon Seok Choi ◽

Eun Hui Bae ◽

Seong Kwon Ma ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Kidney Injury ◽

Sepsis And Septic Shock

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Faculty Opinions recommendation of Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1168327.630494 ◽

2009 ◽

Author(s):

Matthieu Legrand

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Leukocytic Infiltration

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Faculty Opinions recommendation of BCL2 genetic variants are associated with acute kidney injury in septic shock*.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717952982.793458534 ◽

2012 ◽

Author(s):

Nigel Webster

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Genetic Variants ◽

Kidney Injury

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Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)

Clinical Kidney Journal ◽

10.1093/ckj/sfab029 ◽

2021 ◽

Author(s):

Toby J L Humphrey ◽

Glen James ◽

Eric T Wittbrodt ◽

Donna Zarzuela ◽

Thomas F Hiemstra

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Clinical Practice ◽

Clinical Outcomes ◽

Kidney Injury ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Ckd Stage ◽

First Occurrence ◽

Baseline Characteristics

Abstract Background Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. Methods This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Results Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. Conclusions These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.

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Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Blood Purification ◽

10.1159/000512351 ◽

2021 ◽

pp. 1-10

Author(s):

Guang Fu ◽

Hai-chao Zhan ◽

Hao-li Li ◽

Jun-fu Lu ◽

Yan-hong Chen ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Piecewise Linear ◽

Kidney Injury ◽

Multiple Logistic Regression ◽

Primary Analysis ◽

Female Patients ◽

Potential Biomarker ◽

The Relationship

Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

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