Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A <i>Post Hoc</i> Analysis of the AKIKI Randomized Clinical Trial

Gaudry, Stéphane; Hajage, David; Schortgen, Frédérique; Martin-Lefèvre, Laurent; Verney, Charles; Pons, Bertrand; Boulet, Éric; Boyer, Alexandre; Chevrel, Guillaume; Lerolle, Nicolas; Carpentier, Dorothée; Prost, Nicolas de; Lautrette, Alexandre; Bretagnol, Anne; Mayaux, Julien; Nseir, Saad; Mégarbane, Bruno; Thirion, Marina; Forel, Jean-Marie; Maizel, Julien; Yonis, Hodane; Markowicz, Philippe; Thiéry, Guillaume; Tubach, Florence; Ricard, Jean‐Damien; Dreyfuss, Didier

doi:10.1164/rccm.201706-1255oc

Cited by 69 publications

(54 citation statements)

References 36 publications

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“…In addition, 37% of the patients in the delayed arm did not require RRT, indicating the risk of unnecessary treatment in the early initiation group. The data confirm a secondary analysis of the AKIKI trial focussing on sepsis and ARDS showing similar results [12]. In addition, there may be a subgroup of patients suffering from CKD for which early RRT based on AKI stage may even be detrimental with respect to survival and need for RRT [13].…”

supporting

confidence: 75%

Focus on critical care nephrology

2019

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supporting

confidence: 75%

Focus on critical care nephrology

2019

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“…Then, in a recent post hoc analysis of the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial in 174 patients in each arm with septic shock, no difference in 60 day mortality was seen between the early and delayed arms. A significant increase was seen in renal recovery, as measured by urine output, in patients in the delayed arm 197. These findings, suggesting benefits of delayed RRT, were not replicated by a recent trial investigating timing of RRT in ICU patients (32% with severe sepsis) 186.…”

Section: Renal Replacement Therapymentioning

confidence: 87%

Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

516

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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“…Initiation of RRT corrects metabolic acidosis secondary to AKI and improves oxygenation in volume overload [41]. However, the best modality, timing and intensity to optimize respiratory function are unknown [42]. The role of immune modulating interventions is poorly established [43].…”

Section: Rationalementioning

confidence: 99%

“…Reduced mortality in patients with AKI and ARDS [37] C accumulation may be important to reduce further damage to the injured lung [82,90]. However, earlier initiation of RRT in patients with severe AKI and ARDS has not been shown to improve outcome [42,91]. Data on the direct effects of RRT on the lung are sparse and mostly from patients with ESRD receiving IHD.…”

Section: [Sg] Patientsmentioning

confidence: 99%

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

et al. 2019

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Background: Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods:A consensus conference on the spectrum of lung-kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Conclusion:The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung-kidney interactions to improve care processes and outcomes in critical illness.

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Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial

Cited by 69 publications

References 36 publications

Focus on critical care nephrology

Focus on critical care nephrology

Sepsis associated acute kidney injury

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

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