1404. A Pharmacokinetic Study on CMS and Colistin and Its Impact on Clinical Cure and Acute Kidney Injury in Critically Ill Patients with Normal Renal Function from South India

Purpose: Endothelial-like vascular progenitor cells (VPCs) are blood-derived angiogenic precursors that can facilitate vascular repair. The mobilization of peripheral blood VPCs and their role in recovery were investigated in patients with acute kidney injury (AKI) in the intensive care unit (ICU) setting. Methods: Blood samples were drawn on days 0, 3, 7 and 14 in 38 patients admitted to ICU: 30 with AKI and in eight controls with normal renal function. Circulating VPC levels were quantified by the early outgrowth cell cluster-forming assay and/or by flow cytometry. Results: AKI patients (16 males, mean age 62.4) were classified as Risk (R, n=5), Injury (I, n=11) and Failure (F, n=14) according to the RIFLE criteria. VPC clusters increased over time following the diagnosis of AKI (p < 0.01 for day 0 vs. day 14) while VPC clusters were higher at enrollment in control patients and decreased over time (p=0.02). Greater mobilization of VPCs occurred in patients with more severe AKI at enrollment (I and F categories compared with R, p=0.05). A trend towards greater mobilization of VPC clusters was observed in patients with improved renal function (p=0.07). Conclusion: Time-dependent increases in circulating VPCs occur in critically ill patients with established AKI. Greater mobilization of VPCs may be associated with recovery of renal function, suggesting a potential role for VPCs in repair after kidney injury.

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Hypomagnesemia as a risk factor for the non-recovery of the renal function in critically ill patients with acute kidney injury

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfs268 ◽

2012 ◽

Vol 28 (4) ◽

pp. 910-916 ◽

Cited By ~ 34

Author(s):

S. C. Alves ◽

C. D. Tomasi ◽

L. Constantino ◽

V. Giombelli ◽

R. Candal ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Risk Factor ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

Critical Care Research and Practice ◽

10.1155/2013/406075 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Christopher J. Kirwan ◽

Barbara J. Philips ◽

Iain A. M. MacPhee

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Glomerular Filtration Rate ◽

Critically Ill ◽

Cystatin C ◽

Critically Ill Patients ◽

Filtration Rate ◽

Kidney Injury ◽

Serum Cystatin C ◽

Serum Cystatin

Introduction.RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI), but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR) can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI.Aim.This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl) in critically ill patients with AKI.Methods.Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl.Results.eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD).Conclusions.eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.

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Acute Kidney Injury and Septic Shock—Defined by Updated Sepsis-3 Criteria in Critically Ill Patients

Journal of Clinical Medicine ◽

10.3390/jcm8101731 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1731 ◽

Cited By ~ 1

Author(s):

Vin-Cent Wu ◽

Shih-Chieh Jeff Chueh ◽

Jui-Ting Chang ◽

Bang-Gee Hsu ◽

Marlies Ostermann ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Function ◽

Risk Factor ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Acute Dialysis ◽

Sepsis And Septic Shock

Sepsis is commonly associated with acute kidney injury (AKI), particularly in those requiring dialysis (AKI-D). To date, Sepsis-3 criteria have not been applied to AKI-D patients. We investigated sepsis prevalence defined by Sepsis-3 criteria and evaluated the outcomes of septic-associated AKI-D among critically ill patients. Using the data collected from a prospective multi-center observational study, we applied the Sepsis-3 criteria to critically ill AKI-D patients treated in intensive care units (ICUs) in 30 hospitals between September 2014 and December 2015. We described the prevalence, outcomes, and characteristics of sepsis as defined by the screening Sepsis-3 criteria among AKI-D patients, and compared the outcomes of AKI-D patients with or without sepsis using the Sepsis-3 criteria. A total of 1078 patients (median 70 years; 673 (62.4%) men) with AKI-D were analyzed. The main etiology of AKI was sepsis (71.43%) and the most frequent indication for acute dialysis was oliguria (64.4%). A total of 577 (53.3% of 1078 patients) met the Sepsis-3 criteria, and 206 among the 577 patients (19.1%) had septic shock. Having sepsis and septic shock were independently associated with 90-day mortality among these ICU AKI-D patients (hazard ratio (HR) 1.23 (p = 0.027) and 1.39 (p = 0.004), respectively). Taking mortality as a competing risk factor, AKI-D patients with septic shock had a significantly reduced chance of weaning from dialysis at 90 days than those without sepsis (HR 0.65, p = 0.026). The combination of the Sepsis-3 criteria with the AKI risk score led to better performance in forecasting 90-day mortality. Sepsis affects more than 50% of ICU AKI patients requiring dialysis, and one-fifth of these patients had septic shock. In AKI-D patients, coexistent with or induced by sepsis (as screened by the Sepsis-3 criteria), there is a significantly higher mortality and reduced chance of recovering sufficient renal function, when compared to those without sepsis.

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Discontinuation of renal replacement therapy in critically ill patients with severe acute kidney injury: predictive factors of renal function recovery

International Urology and Nephrology ◽

10.1007/s11255-018-1947-1 ◽

2018 ◽

Vol 50 (10) ◽

pp. 1845-1851 ◽

Cited By ~ 6

Author(s):

Helmut Schiffl

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Predictive Factors ◽

Critically Ill Patients ◽

Kidney Injury ◽

Renal Function Recovery ◽

Function Recovery

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Effects of early dialysis on the outcomes of critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

Scientific Reports ◽

10.1038/s41598-019-54777-9 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Wei-Ting Lin ◽

Chih-Cheng Lai ◽

Shen-Peng Chang ◽

Jian-Jhong Wang

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Randomized Controlled Trials ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference

AbstractThe appropriate timing for initiating renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) remains unknown. This meta-analysis aims to assess the efficacy of early initiation of RRT in critically ill patients with AKI. The Pubmed, Embase and Cochrane databases were searched up to August 13, 2019. Only randomized controlled trials (RCTs) comparing the effects of early and late RRT on AKI patients were included. The primary outcome was 28-day mortality. Eleven RCTs including 1131 and 1111 AKI patients assigned to early and late RRT strategies, respectively, were enrolled in this meta-analysis. The pooled 28-day mortality was 38.1% (431/1131) and 40.7% (453/1111) in the patients assigned to early and late RRT, respectively, with no significant difference between groups (risk ratio (RR), 0.95; 95% CI, 0.78–1.15, I2 = 63%). No significant difference was found between groups in terms of RRT dependence in survivors on day 28 (RR, 0.90; 95% CI, 0.67–1.25, I2 = 0%), and recovery of renal function (RR, 1.03; 95% CI, 0.89–1.19, I2 = 56%). The early RRT group had higher risks of catheter-related infection (RR, 1.7, 95% CI, 1.01–2.97, I2 = 0%) and hypophosphatemia (RR, 2.5, 95% CI, 1.25–4.99, I2 = 77%) than the late RRT group. In conclusion, an early RRT strategy does not improve survival, RRT dependence, or renal function recovery in critically ill patients with AKI in comparison with a late RRT strategy. However, clinicians should be vigilant because early RRT can carry higher risks of catheter-related infection and hypophosphatemia during dialysis than late RRT.

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