Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II

Tumlin, James A.; Murugan, Raghavan; Deane, Adam M.; Ostermann, Marlies; Busse, Laurence W.; Ham, Kealy R.; Kashani, Kianoush; Szerlip, Harold M.; Prowle, John R.; Bïhorac, Azra; Finkel, Kevin W.; Zarbock, Alexander; Forni, Lui G.; Lynch, Shannan J.; Jensen, Jeff; Kroll, Stew; Chawla, Lakhmir S.; Tidmarsh, George F.; Bellomo, Rinaldo

doi:10.1097/ccm.0000000000003092

Cited by 218 publications

(150 citation statements)

References 39 publications

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“…Although surprising, these findings may be valid given that larger animals better mimic the human cardiovascular response in sepsis 90100101102. More specifically, ovine autoregulatory responses in untreated shock and shock treated with vasoactive drugs are similar to those in human kidneys with AKI 100101103. Increased investigation of the interplay of the inflammatory cytokines and infiltrating cells and apoptosis will further our knowledge on the effect of these factors on the renal histology and the macrocirculation and microcirculation.…”

Section: Pathobiology Of Sa-akimentioning

confidence: 91%

“…The selection of the ideal vasopressor in the setting of shock (regardless of AKI status) has been the source of several large scale multicenter trials 103131132133134135. In the setting of SA-AKI, traditional agents such as norepinephrine (noradrenaline), epinephrine, vasopressin, and dopamine, as well as more novel agents such as angiotensin II and levosimendan, have been investigated.…”

Section: Prevention and Medical Treatmentmentioning

confidence: 99%

“…Angiotensin II, a hormone in the renin-angiotensin-aldosterone system, is a novel agent recently investigated in the setting of shock 103135. In the Angiotensin II for the Treatment of High Output Shock (ATHOS-3) trial, 344 patients with vasodilatory shock (259 of whom had sepsis) who were receiving 0.2 µg/kg/min (or equivalent) of a vasopressor were randomized to receive either angiotensin II or placebo 135.…”

Section: Prevention and Medical Treatmentmentioning

confidence: 99%

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Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

514

381

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Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.

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Section: Pathobiology Of Sa-akimentioning

confidence: 91%

Section: Prevention and Medical Treatmentmentioning

confidence: 99%

Section: Prevention and Medical Treatmentmentioning

confidence: 99%

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Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

514

381

View full text Add to dashboard Cite

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“…However, the kidney effects are unclear in patients with vasodilatory shock treated with angiotensin II because of inconsistent, albeit not statistically significant, findings in ATHOS‐3 on incidences of AKI (lower with angiotensin II), creatinine increase more than 50% (higher with angiotensin II), and initiation of dialysis (higher with angiotensin II) . Interestingly, a post hoc analysis of ATHOS‐3 found lower short‐term mortality in patients with established AKI treated with renal replacement therapy at baseline who were randomized to angiotensin II . Together, these data show that angiotensin II has multiple and varied effects on vascular beds that may lead to organ‐specific ADRs for which clinicians must monitor.…”

Section: Adrs Of Angiotensin II and Risk Mitigationmentioning

confidence: 98%

Safe Use of Vasopressin and Angiotensin II for Patients with Circulatory Shock

2018

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Circulatory shock is a medical emergency that requires rapid intervention to optimize patient outcomes. Although catecholamine vasopressors are considered life‐sustaining therapy, they are associated with adverse reactions, and vasopressin and angiotensin II may be used to minimize these adverse effects. However, vasopressin and angiotensin II are also associated with adverse reactions that must be known to the clinician to mitigate risk for patients. This review focuses on the known adverse drug effects of vasopressin and angiotensin II while offering potential solutions to minimize harm with these agents. Future directions with vasoactive medication safety including optimization of the electronic medical record, clinical decision support, prediction analytics, and precision medicine for patients with circulatory shock are also discussed.

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“…The investigators showed a significant decrease in the incidence of postoperative AKI when the KDIGO bundle was implemented. More recently, angiotensin II, a newly approved drug for septic or distributive shock (ATHOS-3 trial) [103], showed improved liberation from RRT at day 7 in a post hoc analysis of AKI patients [104]. These findings open an interesting prospect for further research focusing on AKI recovery in critically ill patients with shock that require RRT.…”

Section: Acute Kidney Injury and Critical Care Nephrologymentioning

confidence: 99%

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

et al. 2018

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Background: Although renal replacement therapy prevents death from uremia, survival among patients with acute and chronic kidney diseases (CKD) remains an imperative concern. The expected life span of US dialysis patients 60–64 years of age is approximately 4.5 years; this is similar to that of patients with lung cancer. Despite substantial progress in many medical specialties over the past decades (e.g., notable reductions in myocardial infarction, stroke, and mortality rates in the general population), survival among dialysis patients has not improved significantly over the same period. A few decades ago, HIV infection and AIDS were pretty much a death sentence. Because of progress in HIV treatment, now it can be controlled with a daily pill, and ongoing research is pushing treatment even further and controls the virus with longer-acting treatment. A cure is no longer impossible for HIV and other viral infections such as hepatitis B and C and many malignancies, but so far there is no cure for CKD. Summary: Billions of dollars have been spent on kidney disease research in the past decades, with no tangible progress in clinical practice. The challenges of improving the quantity and quality of trials in nephrology are enormous. The number of randomized controlled trials (RCTs) published in nephrology is lower than that in other medical subspecialties, and most of the big RCTs in nephrology yield negative results. Nephrology studies evaluating hard clinical endpoints or surrogate endpoints are scarce. Key Message: Herein we discuss the slow progress in nephrology research that has impacted clinical practice over the last couple of decades and highlight the major obstacles, challenges, and potential solutions.

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Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II

Abstract: Supplemental Digital Content is available in the text.

Cited by 218 publications

References 39 publications

Sepsis associated acute kidney injury

Sepsis associated acute kidney injury

Safe Use of Vasopressin and Angiotensin II for Patients with Circulatory Shock

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

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