Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics

Abstract

OBJECTIVES: Compare ICU outcomes and respiratory system mechanics in patients with and without acute kidney injury during invasive mechanical ventilation. DESIGNS: Retrospective cohort study. SETTINGS: ICUs of the University of California, San Diego, from January 1, 2014, to November 30, 2016. PATIENTS: Five groups of patients were compared based on the need for invasive mechanical ventilation, presence or absence of acute kidney injury per the Kidney Disease: Improving Global Outcomes criteria, and the temporal relationship between the development of acute kidney injury and initiation of invasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 9,704 patients were included and 4,484 (46%) required invasive mechanical ventilation; 2,009 patients (45%) had acute kidney injury while being treated with invasive mechanical ventilation, and the mortality rate for these patients was 22.4% compared with 5% in those treated with invasive mechanical ventilation without acute kidney injury (p < 0.01). Adjusted hazard of mortality accounting for baseline disease severity was 1.58 (95% CI, 1.22–2.03; p < 0.001]. Patients with acute kidney injury during invasive mechanical ventilation had a significant increase in total ventilator days and length of ICU stay with the same comparison (both p < 0.01). Acute kidney injury during mechanical ventilation was also associated with significantly higher plateau pressures, lower respiratory system compliance, and higher driving pressures (all p < 0.01). These differences remained significant in patients with net negative cumulative fluid balance. CONCLUSIONS: Acute kidney injury during invasive mechanical ventilation is associated with increased ICU mortality, increased ventilator days, increased length of ICU stay, and impaired respiratory system mechanics. These results emphasize the need for investigations of ventilatory strategies in the setting of acute kidney injury, as well as mechanistic studies of crosstalk between the lung and kidney in the critically ill.

Incidence and predictors of acute kidney injury among adults admitted to the medical intensive care unit of a Comprehensive Specialized Hospital in Central Ethiopia

“…In this study, 184(58.0%) of the study participants were male, of which 76(41.3%) of them developed Acute Kidney Injury [ 32 ] whereas 133(39.1%) female participants developed AKI during their ICU stay. The mean age of the study participants was 54.4 years (SD ±18.19356) with a minimum of 19 years and a maximum of 97 years.…”

“…Additionally, invasive mechanical ventilation is attributed to the clinical consequences that lead to altered renal hemodynamics [ 47 ]. This leads to hypo perfusion to the kidney tissue due to low cardiac output that impaired venous return and leads to ischemic injury that is termed acute renal tubular necrosis [ 32 ]. Finally, this leads to a decline in glomeruli filtration rate and elevation of serum creatinine causing the sign of Acute Kidney Injury.…”

Incidence, Outcomes, and Predictors of Subphenotypes of Acute Kidney Injury among Acute Respiratory Distress Syndrome Patients: A Prospective Observational Study

“…Firstly, DP has been shown to be the best ventilator parameter for predicting mortality in ARDS, and higher DP has also been associated with AKI. 21 , 22 Secondly, in a recent study, patients with non-recovery of AKI were associated with severe ARDS, which explains that the DRONE score encompassing poorer oxygenation can predict AKI subphenotype 2. 23 …”

“…Apart from these, literature shows that shock and comorbid illnesses like hypertension and malignancy are associated with non-recovery of AKI in ARDS patients. 22 It is notable, that co-morbid illnesses are part of the calculation of DRONE score as well since it incorporates APACHE II and mNUTRIC score. Likewise, the presence of shock is incorporated in the SOFA score used for calculation of the DRONE score.…”

Morphofunctional state of the kidneys of laboratory rats during acute respiratory distress syndrome

“…In the ARDSnet study, the 180-day mortality rate was much higher in those who had AKI compared to those who did not develop this complication (58% and 28%, respectively) [8]. One retrospective study demonstrated an increase in the number of days of artificial lung ventilation (ILV) (10 vs. 7 days) and the duration of switching to independent breathing (41 vs. 21 hours) in patients with ARDS complicated by AKI compared to ARDS alone [11]. A. Panitchote et al [12] concluded that two-thirds of patients with ARDS developed AKI during intensive care, and almost half of these patients progressed to stage III of AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification.…”