The effects of vasopressin on acute kidney injury in septic shock

Abstract

Kidney injury was present in 464 patients (59.6%) at study entry. In patients in the RIFLE "Risk" category (n=106) vasopressin as compared with norepinephrine was associated with a trend to a lower rate of progression to renal "Failure" or "Loss" categories (20.8% v 39.6% respectively, p=0.03), and a lower rate of use of renal replacement therapy (17.0% v 37.7%, p=0.02). Mortality rates in the "Risk" category patients treated with vasopressin compared to norepinephrine were 30.8% v 54.7%, p=0.01, but this did not reach significance in a multiple logistic regression analysis (OR=0.33, 99%CI 0.10-1.09, p=0.02). The interaction of treatment group and RIFLE category was significant in predicting mortality. Conclusions:Vasopressin may reduce progression to renal failure and mortality in patients at risk of kidney injury who have septic shock.

Vasopressin versus noradrenaline as initial therapy in septic shock. Is vasopressin-related renal protection doomed to “vanish” in the haze?

“…Being encapsulated, the kidneys are also extremely vulnerable to compression by evolving edema. The VASST study reported no significant differences in fluid volume, fluid balance, or diuretic use during the first 4 days between vasopressinand noradrenaline-treated patients at risk for SAKI (3). However, no data on baseline or serial preload measurement were provided.…”

Did the beneficial renal outcomes with vasopressin VANISH?

“…Prior studies have shown a positive effect of AVP use on kidney function (3,7,17) and a positive interaction between AVP and corticosteroid use (4,18), both findings which were not corroborated in VANISH. There are many differences in the prior trials and VANISH, including how AVP was utilized and the timing of corticosteroid initiation.…”

Abdominal pressure and gastrointestinal function: an inseparable couple?

“…A post hoc analysis of the VASST trial found that a subgroup of patients had a lower progression rate to renal failure [86]. The physiological rationale is that vasopressin constricts the efferent as opposed to NA predominantly constricting the afferent renal vessel [86].…”