Potential Interventions in Sepsis-Related Acute Kidney Injury

Ronco, Claudio; Kellum, John A.; Bellomo, Rinaldo; House, Andrew A.

doi:10.2215/cjn.03830907

Cited by 77 publications

(61 citation statements)

References 148 publications

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“…The high incidence of sepsis and associated mortality risk in ICU patients are constant concerns [20,21] . Sepsis is also a well-known risk factor for AKI; 35%-50% of AKI cases in ICUs are attributable to sepsis [18,22,23] .…”

Section: Severe Sepsis and Septic Shockmentioning

confidence: 99%

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Lin

Chen

2012

WJCCM

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Acute kidney injury (AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is that intensive care unit patients tend to be older and more debilitated than before. Pathophysiological factors associated with AKI are also implicated in the failure of other organs, indicating that AKI is often part of a multiple organ failure syndrome. Until recently, there was a lack of consensus as to the best definition, characterization, and evaluation of acute renal failure. This lack of a standard definition has been a major impediment to progress in clinical and basic research. The introduction of the risk, injury, failure, loss, and end-stage kidney disease criteria and the modified version proposed by the Acute Kidney Injury Network have increased the conceptual understanding of AKI syndrome, and these criteria have been successfully tested in clinical studies. This article reviews current findings concerning the application of these criteria for assessing epidemiology and predicting outcome in specific homogeneous critically ill patient groups.

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Section: Severe Sepsis and Septic Shockmentioning

confidence: 99%

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Lin

Chen

2012

WJCCM

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“…Such common acute kidney dysfunction in a critically ill patient and severe complication in the course of septic shock may worsen prognosis. 13 In this cohort, the association between fluid overload and kidney failure was observed in the univariate analysis whereas fluid overload was found to be an independent predictor of kidney failure in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 70%

Fluid overload and kidney failure in children with severe sepsis and septic shock: A cohort study

Romero¹,

Meléndez

2017

Arch Argent Pediat

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Introduction. In children with sepsis, fluid overload as a result of an aggressive fluid replacement or excessive fluid administration may result in kidney impairment and increased mortality. Objective. To determine the association between fluid overload and the rate of kidney failure in a group of children with severe sepsis and septic shock. Population and methods. This was a prospective cohort study conducted in the intensive care unit of Hospital Universitario de Pediatría Dr. Agustín Zubillaga (Barquisimeto, Lara State, Venezuela), between March 2013 and May 2016, in children with severe sepsis or septic shock. Results. One hundred and forty-nine patients were included in the analysis. Sepsis predominated in 59.7% of cases; patients' average age was 6.4 ± 3.3 years old, their average weight was 17.8 ± 3.6 kg, 30.2% had fluid overload, and overall mortality was 25.5%. Kidney failure occurred in 16.1% of cases. A binary logistic regression model was used to identify fluid overload (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-4.9, p = 0.028) and shock for more than 2 days (OR: 1.7; 95% CI: 1.3-6.3, p = 0.039) as independent predictors of kidney failure. In addition, a significant increase in the risk of mortality among children with kidney failure and fluid overload was observed as per the Kaplan-Meier method (p= 0.019). Conclusion. Fluid overload and shock for more than 2 days increase the risk for kidney failure in critically ill children with severe sepsis and septic shock.

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“…24 La incidencia de daño renal agudo varía entre 2,5% y 8,5%, y la mortalidad, entre 8% y 90%, dependiendo de la etiología, de la definición empleada y de la modalidad de terapia utilizada. 25,26 E n e l p a c i e n t e s é p t i c o , l a s t é c n i c a s d e d e p u r a c i ó n d e c a r á c t e r c o n t i n u o (hemodiafiltración venovenosa) son mejor toleradas que las de carácter intermitente y que la diálisis peritoneal.…”

Section: Terapia De Sustitución Renalhemofiltración De Alto Volumen Tunclassified

Shock séptico en la Unidad de Cuidados Intensivos. Terapéutica avanzada, inmunoparálisis y genómica. Estado del arte

R³

et al. 2014

Arch Argent Pediat

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New and important concepts have emerged for the advanced management of the child with septic shock in the recent decades. Attending physicians in the Pediatric intensive care unit must be fully aware of them to improve patient care in the critical care unit. It should be considered the use of immune therapy only in selected groups of patients. Continuous renal replacement therapies are well tolerated and their early use prevents deleterious fluid overload. Removal of inflammatory mediators by using high volume hemofiltration may play a role in hyperdynamic septic patients. The use of plasmapheresis is recommended in patients with thrombocytopenia-associated multiple organ failure. Extracorporeal support use should be considered in those with refractory septic shock despite goals directed therapy. The immunoparalysis has been associated with nosocomial infections and late mortality. The information from genetic markers may allow early intervention and preventive genomicsbased medicine.

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Potential Interventions in Sepsis-Related Acute Kidney Injury

Cited by 77 publications

References 148 publications

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Fluid overload and kidney failure in children with severe sepsis and septic shock: A cohort study

Shock séptico en la Unidad de Cuidados Intensivos. Terapéutica avanzada, inmunoparálisis y genómica. Estado del arte

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