Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy

Passos, Rogério da Hora; Ramos, João Gabriel Rosa; Gobatto, André Luiz Nunes; Mendonça, Evandro Jose Bulhoes; Miranda, Eva Alves; Dutra, Fábio Ricardo Dantas; Coelho, Maria Fernanda R; Pedroza, Andrea; Batista, Paulo Benígno Pena; Dutra, Margarida Maria Dantas

doi:10.1097/md.0000000000005112

Cited by 27 publications

(19 citation statements)

References 31 publications

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“…In the present study, lactate levels were the most critical risk factor for the participants. Lactate levels are known to reflect the condition of critically ill patients, and their prognostic value had been identified in previous studies of patients with sepsis [25][26][27], and patients who required CRRT [28,29]. Our results support those findings.…”

Section: Discussionsupporting

confidence: 91%

Using Sepsis-3 criteria to predict prognosis of patients receiving continuous renal replacement therapy for community-acquired sepsis: a retrospective observational study

Akiu¹,

Yamamoto²,

Miyazaki³

et al. 2018

Ren Replace Ther

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Background: The definition and guideline of sepsis and septic shock were recently updated. The aim of this study is to evaluate the ability of Third Consensus Definitions of Sepsis and Septic Shock (Sepsis-3) to predict outcomes among patients with community-acquired sepsis receiving continuous renal replacement therapy (CRRT). Methods: We conducted a retrospective observational study between January 2013 and December 2015 in a single university hospital. From 368 patients receiving CRRT for various reasons, 64 patients who suffered from communityacquired sepsis and required CRRT were selected and evaluated using the current and previous sepsis criteria. We additionally assessed infection characteristics. The primary outcome was 28-day mortality, and the secondary outcome was in-hospital mortality. Results: Of the 64 participants (70.3% male, median age 66.5 years), 33 (51.6%) administered antimicrobials before admission. The most common source of infections was pneumonia, and 27 participants (42.2%) had positive cultures. The Sepsis-3 criteria identified 64 cases (100%) as sepsis at the start of CRRT, while the previous criteria identified 44 cases (68.8%). According to the Sepsis-3 criteria, the 28-day mortality of sepsis and septic shock were 31.3% (20/64) and 46% (17/37), and in-hospital mortality was 43.8% (28/64) and 62.2% (23/37), respectively. Septic shock diagnosed using the Sepsis-3 criteria predicted mortality (log-rank P = 0.0001); however, using the previous criteria was not associated with mortality (log-rank P = 0.437). Among variables, lactate levels ≥ 2 mmol/L and SOFA score ≥ 14 were significantly associated with mortalities, with an optimal cutoff value for lactate of 1.8 mmol/L (AUC 0.777, sensitivity 85.7%, specificity 58.3%). Although age ≥ 65 years predicted in-hospital mortality, and pre-hospital antimicrobial therapy tended to be associated with 28-day mortality, we did not detect any association between outcomes and the CRRT regimen or general risk factors (e.g., acute kidney injury, serum creatinine levels, and comorbidities).

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Section: Discussionsupporting

confidence: 91%

Using Sepsis-3 criteria to predict prognosis of patients receiving continuous renal replacement therapy for community-acquired sepsis: a retrospective observational study

Akiu¹,

Yamamoto²,

Miyazaki³

et al. 2018

Ren Replace Ther

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“…Hyperlactatemia is indisputably associated with increased mortality in broad patient populations with sepsis and septic shock [ 18 ], but data on patients with blood culture positive septic AKI requiring CRRT are scarce [ 19 ]. Passos and coworkers examined the association between lactate, lactate clearance and mortality in 186 patients with sepsis according to the formerly used systemic inflammatory response syndrome (SIRS) based criteria and coincident AKI requiring CRRT [ 20 ]. In their study lactate clearance during the first 24 hours of CRRT treatment and lactate at 24 hours were independently associated with 48-hour and 28-day mortality, but lactate at CRRT initiation was not.…”

Section: Discussionmentioning

confidence: 99%

Mortality and associated risk factors in patients with blood culture positive sepsis and acute kidney injury requiring continuous renal replacement therapy—A retrospective study

2021

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Objectives Septic acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) carries a mortality risk nearing 50%. Risk factors associated with mortality in AKI patients undergoing CRRT with blood culture positive sepsis remain unclear as sepsis has been defined according to consensus criteria in previous studies. Methods Risk factors associated with intensive care unit (ICU), 90-day and overall mortality were studied in a retrospective cohort of 126 patients with blood culture positive sepsis and coincident severe AKI requiring CRRT. Comprehensive laboratory and clinical data were gathered at ICU admission and CRRT initiation. Results 38 different causative pathogens for sepsis and associated AKI were identified. ICU mortality was 30%, 90-day mortality 45% and one-year mortality 50%. Immunosuppression, history of heart failure, APACHE II and SAPS II scores, C-reactive protein and lactate at CRRT initiation were independently associated with mortality in multivariable Cox proportional hazards models. Blood lactate showed good predictive power for ICU mortality in receiver operating characteristic curve analyses with AUCs of 0.76 (95%CI 0.66–0.85) for lactate at ICU admission and 0.84 (95%CI 0.72–0.95) at CRRT initiation. Conclusions Our study shows for the first time that lactate measured at CRRT initiation is predictive of ICU mortality and independently associated with overall mortality in patients with blood culture positive sepsis and AKI requiring CRRT. Microbial etiology for septic AKI requiring CRRT is diverse.

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“…Flux analysis of metabolites indicate that the kidney also plays a major role in clearing circulating citrate and lactate (118,119); in the case of gluconeogenesis blockade, as observed in AKI, a decrease in lactate clearance occurs (74). Although some biases exist, lactate clearance has been associated with mortality in AKI (120), as well as metabolic alterations (74). Recent papers indicate a potential toxic role of tubule-derived lactate, with increased fibrogenesis (121).…”

Section: Precursors Accumulationmentioning

confidence: 99%

Tubular Cell Glucose Metabolism Shift During Acute and Chronic Injuries

et al. 2021

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Acute and chronic kidney disease are responsible for large healthcare costs worldwide. During injury, kidney metabolism undergoes profound modifications in order to adapt to oxygen and nutrient shortage. Several studies highlighted recently the importance of these metabolic adaptations in acute as well as in chronic phases of renal disease, with a potential deleterious effect on fibrosis progression. Until recently, glucose metabolism in the kidney has been poorly studied, even though the kidney has the capacity to use and produce glucose, depending on the segment of the nephron. During physiology, renal proximal tubular cells use the beta-oxidation of fatty acid to generate large amounts of energy, and can also produce glucose through gluconeogenesis. In acute kidney injury, proximal tubular cells metabolism undergo a metabolic shift, shifting away from beta-oxidation of fatty acids and gluconeogenesis toward glycolysis. In chronic kidney disease, the loss of fatty acid oxidation is also well-described, and data about glucose metabolism are emerging. We here review the modifications of proximal tubular cells glucose metabolism during acute and chronic kidney disease and their potential consequences, as well as the potential therapeutic implications.

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Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy

Cited by 27 publications

References 31 publications

Using Sepsis-3 criteria to predict prognosis of patients receiving continuous renal replacement therapy for community-acquired sepsis: a retrospective observational study

Using Sepsis-3 criteria to predict prognosis of patients receiving continuous renal replacement therapy for community-acquired sepsis: a retrospective observational study

Mortality and associated risk factors in patients with blood culture positive sepsis and acute kidney injury requiring continuous renal replacement therapy—A retrospective study

Tubular Cell Glucose Metabolism Shift During Acute and Chronic Injuries

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