scholarly journals GDF-15 Predicts In-Hospital Mortality of Critically Ill Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Prospective Study

2021 ◽  
Vol 10 (16) ◽  
pp. 3660
Author(s):  
Jeong-Hoon Lim ◽  
Yena Jeon ◽  
Ji-Sun Ahn ◽  
Sejoong Kim ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Apache Ii ◽  
Increased Risk ◽  
Severity Scores

Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine. This study evaluated the association between GDF-15 and in-hospital mortality among patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Among the multicenter prospective CRRT cohort between 2017 and 2019, 66 patients whose blood sample was available were analyzed. Patients were divided into three groups according to the GDF-15 concentrations. The median GDF-15 level was 7865.5 pg/mL (496.9 pg/mL in the healthy control patients). Baseline characteristics were not different among tertile groups except the severity scores and serum lactate level, which were higher in the third tertile. After adjusting for confounding factors, the patients with higher GDF-15 had significantly increased risk of mortality (second tertile: adjusted hazards ratio [aHR], 3.67; 95% confidence interval [CI], 1.05–12.76; p = 0.041; third tertile: aHR, 6.81; 95% CI, 1.98–23.44; p = 0.002). Furthermore, GDF-15 predicted in-hospital mortality (area under the curve, 0.710; 95% CI, 0.585–0.815) better than APACHE II and SOFA scores. Serum GDF-15 concentration was elevated in AKI patients requiring CRRT, higher in more severe patients. GDF-15 is a better independent predictor for in-hospital mortality of critically ill AKI patients than the traditional risk scoring system such as APACHE II and SOFA scores.

Continuous renal replacement therapy for critically ill patients in the intensive care units of two tertiary hospitals. v1

2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Scores

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.

scholarly journals Impacto de las terapias de depuración extrarrenal en la concentraciones plasmáticas de los antimicrobianos en la Unidad de Cuidados Intensivos

2022 ◽  
Vol 13 (12) ◽  
Author(s):  
Esther Domingo Chiva ◽  
Luisa Maria Charco Roca
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Palabras Clave

En los pacientes críticos con insuficiencia renal aguda es esencial manejar cuidadosamente la dosis de los antimicrobianos, especialmente si se requieren terapias de reemplazo renal continuas. La insuficiencia renal aguda conlleva por sí misma modificaciones clínicamente significativas de los parámetros farmacocinéticos de los fármacos, y la necesidad de terapias de reemplazo renal representa una variable adicional que debe considerarse para evitar una terapia antimicrobiana inadecuada. En muchos casos la eliminación extracorpórea de antimicrobianos puede ser relevante con el consiguiente riesgo de fracaso terapéutico relacionado con la infradosificación y/o posible aparición de resistencias bacterianas. En este escenario clínico, el conocimiento de las propiedades farmacocinéticas y farmacodinámicas de los distintos antimicrobianos es esencial para adaptar las dosis y/o intervalos de dosificación. El propósito de esta revisión es mostrar un resumen actualizado de la evidencia actual de este fenómeno y orientar al posible ajuste de fármacos. Para la elaboración de este manuscrito se ha llevado a cabo una revisión no sistemática de artículos indexados en MEDLINE (PubMed) de los últimos quince años, fecha de actualización diciembre 2019, utilizando las palabras clave “critically ill”, “acute kidney injury”, “antimicrobials”, “continuous renal replacement therapy” y “extracorporeal clearance”. Se excluyeron aquellos artículos realizados en población pediátrica y/o que no estuvieran publicados en inglés o español.

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