Acute Respiratory Distress Syndrome and Risk of AKI among Critically Ill Patients

Abstract

Background and objectives Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.Design, setting, participants, & measurements This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays .24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.Results This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P,0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P,0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P,0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P,0.001).Conclusions ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.

A Protective Kidney-Lung Approach to Improve Outcomes in Mechanically Ventilated Patients

“…The predominant cause of death in ARDS is not hypoxemia, which is one of the defining criteria of ARDS, but multiorgan failure [3] . It is well documented that acute kidney injury (AKI) is the most common organ dysfunction in ARDS patients and that in the presence of AKI the mortality rate increases to more than 40%, with the rate rising with AKI severity [4,5] . Therefore, new therapies that can reduce the morbidity and mortality in AKI are urgently needed.…”

Ventilator-induced lung injury increases expression of endothelial inflammatory mediators in the kidney

“…The kidney is the most common organ affected, and ARDS that leads to AKI carries a mortality of 58% compared with 28% from ARDS alone (7,21).…”

Entanglement of Sepsis, Chronic Kidney Disease, and Other Comorbidities in Patients Who Develop Acute Kidney Injury

“…In patients with ARDS, AKI increased the mortality rate from 20.2% to 42.3%. 78 The 20% mortality rate in the setting of non-AKI ARDS was slightly less than in other recent ARDS studies, 79 but highlights the dramatic decrease in ARDS-associated mortality that has occurred over the past few decades. 80,81 This improvement in patient outcomes has been, in part, a direct result of systematic randomized controlled trials and a well-established network of investigators.…”