Clinical Factors and Outcomes of Dialysis-Dependent End-Stage Renal Disease Patients with Emergency Department Septic Shock

Lowe, Kevin; Heffner, Alan C.; Karvetski, Colleen

doi:10.1016/j.jemermed.2017.09.001

Cited by 9 publications

(5 citation statements)

References 17 publications

(21 reference statements)

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“…Traditionally, providers are more likely to provide overall lower total fluid resuscitation amounts in patients with a past medical history of CKD. A study by Lowe et al 19 provided some insight because investigators stated that the phenomena could be secondary to a combination of decreased fluid resuscitation and plasma hormones when compared with non-CKD patients. The decreased fluid resuscitation could also predispose the patients with CKD to a negative hemodynamic event.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Effects of Propofol and Dexmedetomidine in Septic Patients Without Shock

et al. 2019

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Background: Use of nonbenzodiazepine agents propofol and dexmedetomidine are first line for sedation in the intensive care unit (ICU). These agents have been implicated in the development of bradycardia and hypotension in critical illness. Objectives: To compare the development of clinically significant hypotension and/or bradycardia (ie, negative hemodynamic event) in adults with sepsis yet to require vasopressors receiving either propofol or dexmedetomidine for continuous sedation. Methods: This was a retrospective multicenter cohort study of adults with non–vasopressor-dependent sepsis admitted to an ICU at two academic medical centers between July 2013-September 2017. Results: Patients in the propofol (n = 64) and dexmedetomidine (n = 31) groups developed a clinically significant negative hemodynamic event at statistically similar frequencies (34.4% vs 16.1%, P = 0.065). Patients receiving propofol developed a larger degree of hypotension (47.3 vs 34.7 mm Hg reduction, P = 0.031). In multivariable logistic regression modeling, independent predictors of a negative hemodynamic event were a past medical history of chronic kidney disease (odds ratio [OR] = 3.8; 95% CI = 1.17-12.2; P = 0.027) and baseline heart rate (OR = 1.02; 95% CI = 1.00-1.10; P = 0.036). Conclusions and Relevance: A minority of patients with sepsis who received either propofol or dexmedetomidine experienced an event. Patients with sepsis without shock receiving continuous infusions of propofol and dexmedetomidine experienced a negative hemodynamic event at similar frequencies, though the degree of hypotension seen with propofol was greater. The clinical significance of these adverse effects requires cautious use in sepsis and further investigation.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic Effects of Propofol and Dexmedetomidine in Septic Patients Without Shock

et al. 2019

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“…noted in their observational study ( n = 166) that septic patients with renal failure required more frequent use of vasopressor therapy compared with patients without renal failure [ 2 , 36 ]. This is probably because it is clinically challenging to determine dialysis patients’ intravascular volume status and fluid responsiveness [ 18 ]. Moreover, physicians may be reluctant to give IV fluid resuscitation to ESRD patients as they assume volume overload in dialysis-dependent patients and may be more inclined to start these patients on vasopressors.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, physicians may be reluctant to give IV fluid resuscitation to ESRD patients as they assume volume overload in dialysis-dependent patients and may be more inclined to start these patients on vasopressors. According to Lowe et.al ( n = 137), ESRD septic shock patients received less fluid resuscitation (11 mL/kg in the first 3 h) compared with non-ESRD septic shock patients despite having similar presenting physiologic variables and shock markers [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, according to Sarnak and Lowe, Age, DM and hyperlactatemia were associated with a higher rate of death in ESRD septic patients [ 13 , 18 ]. Our results have shown that the factors associated with an increased ICU and hospital mortality were a co-existing history of liver disease, mechanical ventilation, incremental increase in the APACHE II score, and the use of vasopressors.…”

Section: Discussionmentioning

confidence: 99%

“…Lowe et al. looked at the mortality of haemodialysis patients in septic shock ( n = 137) and found that their ESRD patients had a mortality of 20.4% vs. 17% in non-ESRD patients [ 18 ]. However, both of these studies were done in the Emergency Department and they were limited by their small sample size.…”

Section: Introductionmentioning

confidence: 99%

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Sepsis in end-stage renal disease patients: are they at an increased risk of mortality?

et al. 2021

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Objectives This study aims to examine the outcome of end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU). Design Single centre, retrospective cohort study Setting The study was conducted in the Intensive Care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Participants Data were extracted from a prospectively collected ICU database from 2002 to 2017. Patients were considered to have sepsis based on the sepsis-3 definition and were stratified into 2 groups based on the presence or absence of ESRD. Primary and secondary outcomes The primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, and mechanical ventilation duration. Results A total of 8803 patients were admitted to the ICU with sepsis during the study period. 730 (8.3%) patients had ESRD. 49.04% of ESRD patients with sepsis died within their hospital stay vs. 31.78% of non-ESRD patients. ESRD septic patients had 1.44 greater odds of dying within their hospital stay as compared to septic non-ESRD patients (OR 1.44, 95% CI 1.03–1.53). Finally, the predictors of hospital mortality in septic ESRD patients were found to be mechanical ventilation (OR 3.36; 95% CI 2.27–5.00), a history of chronic liver disease (OR 2.26; 95% CI 1.26–4.07), and use of vasopressors (OR 1.74; 95% CI 1.19–2.54). Among patients with ESRD, hospital mortality was higher in subgroups of patients with chronic cardiac (OR 1.86 (1.36–2.53) vs. 1.19 (0.96–1.47)) and chronic respiratory illnesses (OR 2.20 (1.52–3.20) vs. 1.21 (0.99–1.48)). Conclusion ESRD patients admitted to the intensive care unit with sepsis are at greater odds of mortality compared to patients with non-ESRD. This risk is particularly increased if these patients have a concomitant history of chronic cardiac and respiratory illnesses. Key Messages Sepsis and bacterial infections are very common in ESRD patients and following cardiovascular disease; sepsis is the second leading cause of death in patients with ESRD. This study aims to examine the outcome of patients with end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU). The results of this study have shown that end-stage renal disease is associated with greater odds of ICU and hospital mortality among septic patients admitted to an intensive care unit. ESRD patients were also more likely to be started on vasopressors and mechanical ventilation.

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Aggressive versus conservative fluid resuscitation in septic hemodialysis patients

Rajdev

Leifer

Sandhu

et al. 2021

The American Journal of Emergency Medicine

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Clinical Factors and Outcomes of Dialysis-Dependent End-Stage Renal Disease Patients with Emergency Department Septic Shock

Cited by 9 publications

References 17 publications

Hemodynamic Effects of Propofol and Dexmedetomidine in Septic Patients Without Shock

Hemodynamic Effects of Propofol and Dexmedetomidine in Septic Patients Without Shock

Sepsis in end-stage renal disease patients: are they at an increased risk of mortality?

Aggressive versus conservative fluid resuscitation in septic hemodialysis patients

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