Sepsis-Associated Acute Kidney Disease

Abstract

Introduction: About one-third of critically ill patients with acute kidney injury (AKI) develop persistently decreased kidney function, known as acute kidney disease (AKD), which may progress to chronic kidney disease (CKD). Although sepsis is the most common cause of AKI, little is known about sepsis-associated AKD.Methods: Using data from a large randomized trial including 1341 patients with septic shock, we studied patients with stage 2 or 3 AKI on day 1 of hospitalization. We defined AKD as a persistently reduced glomerular filtration rate for >7 days. In addition to clinical data, we measured several urinary biomarkers (tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2*IGFBP7], neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], liver-type fatty acid binding protein, and type 4 collagen) at 0, 6, and 24 hours, to predict AKD.Results: Of 598 patients, 119 (19.9%) died within 7 days, 318 (53.2%) had early reversal of AKI within the first 7 days, whereas 161 (26.9%) developed AKD. In patients with early reversal, 45 (14.2%) had relapsed AKI after early reversal, and only about one-third of these recovered. Among patients developing AKD, only 15 (9.3%) recovered renal function prior to discharge. Male sex, African American race, and underlying CKD were more predominant in patients developing AKD. None of the biomarkers tested performed well for prediction of AKD, although NGAL modestly increased the performance of a clinical model. Conclusions: AKD is common in patients with septic shock, especially among African American males and those with underlying CKD. Existing AKI biomarkers have limited utility for predicting AKD but might be useful together with clinical variables. Novel predictive biomarkers for renal recovery are needed.

Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children

“…This is the first report in a large population of pediatric population, to our knowledge, to incorporate contemporary recommendations for clinical adjudication of AKI diagnosis. Although our findings validate the findings in adult septic patients, 1 , 2 , 4 , 10 , 25 we demonstrate unique downstream sequelae based on AKI duration and severity. Significant differences in the associations with mortality and ICU resource utilization exist between mild forms of S-AKI and severe forms of AKI.…”

Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

“…16 , 33 Patients with AKI that evolves into acute kidney disease show greater long-term eGFR decreases than patients with AKI who do not develop acute kidney disease. 34 Older age, male sex, Black race, underlying CKD, and AKI severity are known risk factors for AKI progression to acute kidney disease 35 , 36 ; however, the accelerated eGFR decrease following COVID-19–associated AKI persisted after adjusting for these covariates. As in acute tubular necrosis, where patients with acute tubular necrosis due to mixed causes are at higher risk for future CKD than patients with acute tubular necrosis due to a single cause, such as ischemia or nephrotoxins, 37 the multiple concurrent mechanisms of COVID-19–associated AKI may be contributing to the increased eGFR decrease after discharge.…”

Phenotypes and Baseline Risk Factors of Acute Kidney Injury in Children After Allogeneic Hematopoietic Stem Cell Transplantation

“…The clinical relevance of AKD is more obscure. In a large cohort of septic adult patients with AKI, <10% of the patients with AKD recovered renal function, as opposed to those with early AKI reversal, where only 14.2% of patients had further recurrence and one third of those developed ESRD ( 32 ).…”