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

Bagshaw, Sean M.; Lapinsky, Stephen E.; Dial, Sandra; Arabi, Yaseen M.; Dodek, Peter; Wood, Gordon; Ellis, Paul; Guzmán, Jorge; Marshall, John C.; Parrillo, Joseph E.; Skrobik, Yoanna; Kumar, Anand

doi:10.1007/s00134-008-1367-2

Cited by 387 publications

(304 citation statements)

References 34 publications

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“…In the presence of sepsis or septic shock, each hour delay in administration of appropriate antimicrobials is associated with a measurable increase in mortality [57,74]. Further, several studies show an adverse effect on secondary end points (e.g., LOS [75], acute kidney injury [76], acute lung injury [77], and organ injury assessed by Sepsis-Related Organ Assessment score [78] with increasing delays. Despite a meta-analysis of mostly poor-quality studies that failed to demonstrate a benefit of rapid antimicrobial therapy, the largest and highest-quality studies support giving appropriate antimicrobials as soon as possible in patients with sepsis with or without septic shock [57,74,[79][80][81].…”

Section: Rationalementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: Rationalementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…A classic example are the non-steroidal anti-inflammatory drugs and the inhibitors of angiotensin converting enzyme (ACE), which reduce renal perfusion and favor the mechanism of renal injury (21) . The same perception and attention should be given to the indiscriminate and more recent use of vitamin supplements and herbal medications, because many patients do not consider this category as drugs and are unaware of their contribution to the development of AKI (16) .…”

Section: Implications For Practicementioning

confidence: 99%

“…Toxic AKI involves numerous intrinsic factors, some nonmodifiable, such as high age, gender, hypertension, chronic renal failure, congestive heart failure, multiple myeloma and modifiable factors such as dehydration, medication dosage, hypotension, concomitant use of nephrotoxic drugs, shock and sepsis (7,14,21) .…”

Section: Implications For Practicementioning

confidence: 99%

Nephrotoxicity Of Polymyxin B: Experimental Study In Cells And Implications For Nursing Practice

Neiva

Borges

Watanabe

et al. 2014

Rev. esc. enferm. USP

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RESUMENEl objetivo del estudio fue caracterizar los mecanismos de daño celular implicado en la fisiopatología de la citotoxicidad de la polimixina B en las células tubulares proximales (LLC-PK1) y discutir las propuestas de intervención de enfermería para identificar a los pacientes de riesgo y considerar la prevención o el tratamiento de la lesión renal aguda nefrotóxica. Corresponde a un estudio experimental cuantitativo in vitro, en el cual las células fueron expuestas a sulfato de polimixina B. La viabilidad celular se determinó por exclusión de los colorantes fluorescentes y el método morfológico con la visualización de cuerpos apoptóticos a la microscopía de fluorescencia. Las células expuestas a polimixina B demostraron reducción de la viabilidad, aumento de célu-las apoptóticas y mayor concentración de la enzima lactato deshidrogenasa. La administración de polimixina B in vitro demostró la necesidad de realizar acciones en la práctica clínica para minimizar los efectos adversos como la nefrotoxicidad. DESCRIPTORESPolimixina B Antibacterianos Lesión renal aguda Células LLC-PK1 Atención de enfermería RESUMOO objetivo do estudo foi caracterizar os mecanismos de lesão celular envolvidos na fisiopatologia da citotoxicidade da polimixina B em células tubulares proximais (LLC-PK1) e discutir as proposições de intervenção do enfermeiro para identificar os pacientes de risco e considerar a prevenção ou o tratamento para lesão renal nefrotóxica. Estudo experimental in vitro, onde as células foram expostas ao sulfato de polimixina B. A viabilidade celular foi determinada pela exclusão dos corantes fluorescentes e o método morfológico com visualização de corpos apoptóticos à microscopia de fluorescência. As células expostas à polimixina B apresentaram redução de viabilidade, aumento do número de células em apoptose e maior concentração da enzima desidrogenase láctea. A administração de polimixina B in vitro demonstrou a necessidade de ações na prática clínica para minimizar os efeitos adversos como a nefrotoxicidade. DESCRITORESPolimixina B Antibacterianos Lesão renal aguda Células LLC-PK1 Cuidados de enfermagem ABSTRACTThe aim of the study was to characterize the cell damage mechanisms involved in the pathophysiology of cytotoxicity of polymyxin B in proximal tubular cells (LLC -PK1) and discuss about the nurses interventions to identify at risk patients and consider prevention or treatment of nephrotoxicity acute kidney injury. This is a quantitative experimental in vitro study, in which the cells were exposed to 375μM polymyxin B sulfate concentration. Cell viability was determined by exclusion of fluorescent dyes and morphological method with visualization of apoptotic bodies for fluorescence microscopy. Cells exposed to polymyxin B showed reduced viability, increased number of apoptotic cells and a higher concentration of the enzyme lactate dehydrogenase. The administration of polymyxin B in vitro showed the need for actions to minimize adverse effects such as nephrotoxicity.

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“…39,40 Observational data also suggest that delay to appropriate antimicrobials is an important independent factor associated with a higher risk for AKI. 51 Data from the BEST Kidney Study also revealed that 71% of patients with septic AKI required acute RRT, with 85% of patients receiving CRRT as initial therapy. 40 When compared with either non-septic AKI or sepsis alone, several studies have confirmed that septic AKI portends higher adjusted risk of short-and long-term mortality and consumption of additional health resources.…”

Section: Syndromes Of Acute Kidney Injurymentioning

confidence: 99%

“…40 When compared with either non-septic AKI or sepsis alone, several studies have confirmed that septic AKI portends higher adjusted risk of short-and long-term mortality and consumption of additional health resources. 17,[39][40][41]51 Interestingly; however, compared with non-septic AKI, survivors of septic may have a greater likelihood of renal recovery and independence from RRT. 40,52 Cardio-renal syndrome Kidney and cardiac disease are common, increasingly prevalent, and frequently co-exist.…”

Section: Syndromes Of Acute Kidney Injurymentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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

Cited by 387 publications

References 34 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Nephrotoxicity Of Polymyxin B: Experimental Study In Cells And Implications For Nursing Practice

Review article: Acute kidney injury in critical illness

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