Critical Care Nephrology: Core Curriculum 2020

Griffin, Benjamin R.; Liu, Kathleen D.; Teixeira, J. Pedro

doi:10.1053/j.ajkd.2019.10.010

Cited by 76 publications

(78 citation statements)

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“…29,30 AKI is a common complication of patients in ICU settings, which can be caused by various conditions. 31 Septic shock happened in .60% of our patients and was the leading cause for AKI, which was confirmed by the medical history and the pathologic findings of acute tubular injury (Figure 3, Table 6). Several patients with AKI had a history of poor intake and volume loss, and most of them recovered from AKI after fluid supplementation.…”

Section: Discussionsupporting

confidence: 63%

“…3 Viral load in tissues other than the lungs were also reported to be either negative or much lower. 19,36 Considering the median disease course of the ten patients who were autopsied was 34 days (IQR, [28][29][30][31][32][33][34][35][36][37][38][39][40], this might account for the lack of virus detection in the kidneys. Regardless, the renal pathologic changes were predominately acute tubular injury rather than glomerulopathy or interstitial nephritis.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 with Prolonged Disease Course: A Retrospective Cohort

Xia

Wen

Duan

et al. 2020

JASN

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BackgroundThe incidence, severity, and outcomes of AKI in COVID-19 varied in different reports. In patients critically ill with COVID-19, the clinicopathologic characteristics of AKI have not been described in detail.MethodsThis is a retrospective cohort study of 81 patients critically ill with COVID-19 in an intensive care unit. The incidence, etiologies, and outcomes of AKI were analyzed. Pathologic studies were performed in kidney tissues from ten deceased patients with AKI.ResultsA total of 41 (50.6%) patients experienced AKI in this study. The median time from illness to AKI was 21.0 (IQR, 9.5–26.0) days. The proportion of Kidney Disease Improving Global Outcomes (KDIGO) stage 1, stage 2, and stage 3 AKI were 26.8%, 31.7%, and 41.5%, respectively. The leading causes of AKI included septic shock (25 of 41, 61.0%), volume insufficiency (eight of 41, 19.5%), and adverse drug effects (five of 41, 12.2%). The risk factors for AKI included age (per 10 years) (HR, 1.83; 95% CI, 1.24 to 2.69; P=0.002) and serum IL-6 level (HR, 1.83; 95% CI, 1.23 to 2.73; P=0.003). KDIGO stage 3 AKI predicted death. Other potential risk factors for death included male sex, elevated D-dimer, serum IL-6 level, and higher Sequential Organ Failure Assessment score. The predominant pathologic finding was acute tubular injury. Nucleic acid tests and immunohistochemistry failed to detect the virus in kidney tissues.ConclusionsAKI was a common and multifactorial complication in patients critically ill with COVID-19 at the late stage of the disease course. The predominant pathologic finding was acute tubular injury. Older age and higher serum IL-6 level were risk factors of AKI, and KDIGO stage 3 AKI independently predicted death.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Clinicopathological Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 with Prolonged Disease Course: A Retrospective Cohort

Xia

Wen

Duan

et al. 2020

JASN

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“…Around 10%–15% of hospitalized patients suffer from AKI; the incidence is up to 50% in intensive care patients [ 2 ]. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis [ 3 ].…”

Section: Aki and Dialysis In Critically Ill Patientsmentioning

confidence: 99%

Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

Klingele

Baerens

2021

JCM

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Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

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“…Acute kidney injury (AKI) is a common complication that occurs in 50-70% of ICU patients and is associated with worse outcome, with mortality rates of nearly 50% [4].…”

Section: Introductionmentioning

confidence: 99%

A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19

Nalesso

Garzotto

Cattarin

et al. 2020

JCM

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COVID-19 often leads to acute respiratory distress syndrome complicated by acute kidney injury (AKI). The indications for renal replacement therapy for these patients are those commonly accepted to treat AKI. We describe a continuous veno-venous haemodialysis (CVVHD) protocol for AKI, which aims to provide the best treatment according to the particular patient’s and medical personnels’ needs in biohazard settings with limited human and technological resources. We designed a CVVHD protocol with a high cut-off (HCO) filter in regional citrate anticoagulation (RCA). The HCO filter in diffusion determines the enhanced cytokines clearance with less filter clotting due to a lower filtration fraction. In our hospital, at the beginning of the pandemic outbreak, we treated seven COVID-19 patients with AKI stage 2 and 3 and recorded the circuit lifespan and the number of interventions on monitors. CVVHD in RCA appears to be safe, effective and easy to be performed in a biohazard scenario using lower blood flows and less bag changes with fluid savings, a biohazard reduction and sparing of resources. Although the data come from a very small cohort, our protocol seems related to a low mortality.

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Critical Care Nephrology: Core Curriculum 2020

Cited by 76 publications

References 0 publications

Clinicopathological Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 with Prolonged Disease Course: A Retrospective Cohort

Clinicopathological Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 with Prolonged Disease Course: A Retrospective Cohort

Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19

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