Usefulness of urinary NGAL levels during an operation in a patient with septic shock and acute kidney injury for determining postoperative initiation of renal replacement therapy: a case study

Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

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Timing of Continuous Renal Replacement Therapy Initiation in Septic Shock and Acute Kidney Injury

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.12121 ◽

2013 ◽

Vol 17 (6) ◽

pp. 642-643

Author(s):

Tibor Fülöp ◽

Mihály Tapolyai ◽

Neville R Dossabhoy

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Therapy Initiation ◽

Renal Replacement Therapy Initiation

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Coupled-plasma filtration and adsorption for severe burn patients with septic shock and acute kidney injury treated with renal replacement therapy

Burns ◽

10.1016/j.burns.2019.05.017 ◽

2020 ◽

Vol 46 (1) ◽

pp. 190-198 ◽

Cited By ~ 1

Author(s):

Filippo Mariano ◽

Zsuzsanna Hollo’ ◽

Nadia Depetris ◽

Valeria Malvasio ◽

Alberto Mella ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Burn Patients ◽

Severe Burn ◽

Plasma Filtration

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Predictive value of NGAL and KIM-1 on survivors of acute kidney injury requiring dialysis

European Journal of Inflammation ◽

10.1177/2058739219856830 ◽

2019 ◽

Vol 17 ◽

pp. 205873921985683

Author(s):

Meiling Guo ◽

Yanjie Li ◽

Haibo Li

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Predictive Value ◽

Area Under The Curve ◽

Kidney Injury ◽

Youden Index ◽

Urinary Ngal ◽

Ngal Level ◽

Kidney Injury Molecule 1

To investigate the predictive effects of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) on renal-replacement therapy for traumatic acute kidney injury (TAKI). The urinary NGAL and KIM-1 levels of TAKI patients underwent renal-replacement therapy were assessed. The correlation and predictive model were also analyzed. Short-term (28 days) survival rate of patients were 54.5%. As TAKI stage increased, urinary KIM-1 and NGAL level increased significantly ( P < 0.05). The urinary KIM-1 and NGAL level, negatively correlated with 28-day survial, were all higher in deceased patients than survival patients ( P < 0.05). The Youden index demonstrated the predictive value of urinary NGAL area under the curve (AUC; 0.830) and KIM-1 AUC (0.879) levels in the prognosis of patients in this study. NGAL and KIM-1 can predict the prognosis of patients with TAKI and have significant correlation with the prognosis of patients.

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Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a randomized controlled multicenter crossover trial

10.21203/rs.3.rs-21846/v1 ◽

2020 ◽

Author(s):

Fang Liu ◽

Jing Zhang ◽

Yuan Zhu ◽

Lianjiu Su ◽

Yiming Li ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Intravenous Infusion ◽

Crossover Trial ◽

Kidney Injury ◽

Hospital Death ◽

Ringer’S Solution

Abstract Background: The previous study demonstrated that there were no significant differences between saline and balanced crystalloid solution infused in critical illness. However, the sepsis subgroup analysis showed the statistical difference. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion. Methods/design: The investigators designed a pragmatic, multi-centered crossover trial recruiting 312 patients who are diagnosed as sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer's solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrollment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events (MAKE), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay. Results and Conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration. Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214 Keywords: sepsis; septic shock; acute kidney injury; saline; acetate Ringer's solution.

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Faculty Opinions recommendation of Timing for initiation of continuous renal replacement therapy in patients with septic shock and acute kidney injury.

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

10.3410/f.726162204.793514807 ◽

2016 ◽

Author(s):

Giovanni Landoni

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury

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Feasibility and safety of combined cytokine adsorption and continuous veno-venous hemodialysis with regional citrate anticoagulation in patients with septic shock

The International Journal of Artificial Organs ◽

10.1177/0391398819866459 ◽

2019 ◽

Vol 43 (1) ◽

pp. 10-16

Author(s):

Thomas Dimski ◽

Timo Brandenburger ◽

Torsten Slowinski ◽

Detlef Kindgen-Milles

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Regional Citrate Anticoagulation ◽

Adjunct Treatment ◽

Citrate Anticoagulation ◽

Acute Kidney Injury Stage ◽

Norepinephrine Dose

Introduction: Septic shock is characterized by severe metabolic and hemodynamic alterations. It is often accompanied by acute kidney injury. A new adjunct treatment is hemoadsorption using a cytokine adsorber in line with continuous veno-venous renal replacement therapy. We studied the feasibility, efficacy, and safety of cytokine adsorption with citrate-anticoagulated continuous veno-venous hemodialysis (regional citrate anticoagulation–continuous veno-venous hemodialysis). Methods: In 11 patients with septic shock and acute kidney injury stage 3, we studied 12 cycles of cytokine adsorption and regional citrate anticoagulation–continuous veno-venous hemodialysis. We monitored parameters of citrate anticoagulation, circuit lifetime, laboratory parameters, hemodynamics, and vasopressor demand. Results: Ten out of 12 adsorber/continuous veno-venous hemodialysis circuits reached the target lifetime of 24 h for the adsorber. One system clotted and one was stopped for non-device-related reasons. Nine of the remaining continuous renal replacement therapy circuits reached 72 h lifetime. With default settings for regional citrate anticoagulation, serum ionized calcium and pH were in the normal range. Urea and creatinine were reduced significantly, and norepinephrine dose decreased from 0.47 (±0.09) to 0.16 (±0.04) µg/kg/min ( p = 0.016) after 24 h. Discussion: We show that combined cytokine adsorption/continuous veno-venous hemodialysis is effective to control pH, to reduce urea and creatinine, and to improve hemodynamics by reducing norepinephrine doses in patients with septic shock. It can be applied safely with standard settings of regional citrate anticoagulation rendering sufficiently long filter lifetimes for the adsorber and the continuous veno-venous hemodialysis circuit. Further studies are on the way to investigate whether these effects translate into improved outcomes in septic shock patients.

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