Hemodynamic Monitoring in the Critically Ill: Spanning the Range of Kidney Function

Davison, Danielle; Patel, Kanak; Chawla, Lakhmir S.

doi:10.1053/j.ajkd.2011.12.016

Cited by 12 publications

(5 citation statements)

References 83 publications

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“…Additionally, biomarker studies have generally not included newer modes of imaging e.g. Doppler ultrasound, resulting in poor correlations of functional changes with kidney damage 25 , 26 . Finally, very limited information exists on the utility of incorporating these newer biomarkers with creatinine and urine output data to enhance the clinical care of patients with AKI.…”

Section: Opportunities and Challenges For Utilizing Biomarkers For Akmentioning

confidence: 99%

Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference

Murray

Mehta

Shaw

et al. 2014

Kidney International

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388

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Over the last decade there has been considerable progress in the discovery and development of biomarkers of kidney disease, and several have now been evaluated in different clinical settings. While there is a growing literature on the performance of various biomarkers in clinical studies, there is limited information on how these biomarkers would be utilized by clinicians to manage patients with acute kidney injury (AKI). Recognizing this gap in knowledge, we convened the 10th Acute Dialysis Quality Initiative (ADQI) meeting to review the literature on biomarkers in AKI and their application in clinical practice. We asked an international group of experts to assess four broad areas for biomarker utilization for AKI: risk assessment, diagnosis and staging; differential diagnosis; prognosis and management and novel physiological techniques including imaging. This article provides a summary of the key findings and recommendations of the group, to equip clinicians to effectively use biomarkers in AKI.

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Section: Opportunities and Challenges For Utilizing Biomarkers For Akmentioning

confidence: 99%

Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference

Murray

Mehta

Shaw

et al. 2014

Kidney International

Self Cite

388

308

View full text Add to dashboard Cite

show abstract

“…However, most studies were performed in heterogeneous surgical populations without AKI, using different hemodynamic targets and methods of optimization. Experts, including the Kidney Disease Improving Global Outcomes (KDIGO) group, have recommended that physicians consider hemodynamic monitoring in all patients with AKI (15)(16)(17). However, there are no evidence-based data on the optimal hemodynamic targets.…”

Section: Introductionmentioning

confidence: 99%

Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI

Raimundo

Crichton

Syed

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives The optimal hemodynamic management of patients with early AKI is unknown. This study aimed to investigate the association between hemodynamic parameters in early AKI and progression to severe AKI and hospital mortality.Design, setting, participants, & measurements This study retrospectively analyzed the data of all patients admitted to the adult intensive care unit in a tertiary care center between July 2007 and June 2009 and identified those with stage 1 AKI (AKI I) per the AKI Network classification. In patients in whom hemodynamic monitoring was performed within 12 hours of AKI I, hemodynamic parameters in the first 12 hours of AKI I and on the day of AKI III (if AKI III developed) or 72 hours after AKI I (if AKI III did not develop) were recorded. Risk factors for AKI III and mortality were identified using univariate and multivariate logistic regression analyses.Results Among 790 patients with AKI I, 210 (median age 70 years; 138 men) had hemodynamic monitoring within 12 hours of AKI I; 85 patients (41.5%) progressed to AKI III and 91 (43%) died in the hospital. AKI progressors had a significantly higher Sequential Organ Failure Assessment score (8.0 versus 9.6; P,0.001), lower indexed systemic oxygen delivery (DO 2 I) (median 325 versus 405 ml/min per m 2 ; P,0.001), higher central venous pressure (16 versus 13; P=0.02), and lower mean arterial blood pressure (MAP) (median 71 versus 74 mmHg; P=0.01) in the first 12 hours of AKI I compared with nonprogressors. Multivariate analysis confirmed that raised lactate, central venous pressure, and Sequential Organ Failure Assessment score as well as mechanical ventilation were independently associated with progression to AKI III; higher DO 2 I and MAP were independently associated with a lower risk of AKI III but not survival. The associations were independent of sepsis, heart disease, recent cardiac surgery, or chronic hypertension. ConclusionsHigher DO 2 I and MAP in early AKI were independently associated with a lower risk of progression.

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“…A higher target MAP of 80 to 85 mmHg is also suggested in patients with chronic hypertension [17]. However, most studies on hemodynamic targets in patients with AKI have been conducted in critically ill patients [9–16]. Although Liu et al [26] reported that relative decreases in SBP and DBP and MAP were associated with the development of AKI and a decrease in SBP is a significant independent predictor of the development of severe AKI in noncritically ill patients, there is limited knowledge concerning the optimal BP in general ward patients with AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies considering hemodynamic targets in patients with AKI have been performed in critically ill patients [9–16]. Especially in patients with septic AKI or hepatorenal syndrome, a target mean arterial pressure (MAP) of 65 to 70 mmHg has been suggested, while a higher target MAP of 80 to 85 mmHg is recommended in patients with chronic hypertension [17].…”

Section: Introductionmentioning

confidence: 99%

Optimal systolic blood pressure in noncritically ill patients with acute kidney injury: A retrospective cohort study

Baek

Chin

et al. 2019

Kidney Res Clin Pract.

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Background Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI. Methods We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality. Results The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120–129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, P = 0.015; 100–109 mmHg: HR 1.56, P = 0.038; 110–119 mmHg: HR 1.15, P = 0.483; 130–139 mmHg: HR 1.51, P = 0.045; ≥ 140 mmHg: HR 1.73, P = 0.005). Conclusion Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.

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Hemodynamic Monitoring in the Critically Ill: Spanning the Range of Kidney Function

Cited by 12 publications

References 83 publications

Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference

Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference

Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI

Optimal systolic blood pressure in noncritically ill patients with acute kidney injury: A retrospective cohort study

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