CRRT for sepsis-induced acute kidney injury

Abstract

Purpose of review Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between ‘rescue’ indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns). The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed. Recent findings Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far. Summary In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.

Acute Kidney Injury in Septic Patients Treated by Selected Nephrotoxic Antibiotic Agents—Pathophysiology and Biomarkers—A Review

“…The basic principle of these blood purification devices, using more effective membranes or columns incorporated in CRRT, is removal of pro-inflammatory cytokines (e.g., IL-6, IL-8, TNFα) and endotoxins to stabilize the patient’s hemodynamics and decrease the need for vasopressor therapy [ 87 ]. Preserving adequate fluid balance, net ultrafiltration, treatment dose, nutritional support and antibiotic treatment are a vital component of the therapeutic approach in critically ill septic patients [ 88 ].…”

Renal replacement therapies for infants and children in the ICU

“…Finally, several studies have evaluated the approach to RRT for sepsis-induced AKI. Cumulatively, there has been no definitive advantage shown with initiation of RRT for sepsis-induced AKI alone [11].…”

“…Furthermore, the presence of AKI is associated with significantly higher mortality in hospitalized children with mortality rates as high at 30-50% in children requiring RRT [9,10]. However, it is well accepted that effective and appropriately prescribed RRT is associated with significantly better survival [11,12].…”

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea

“…Additionally, it is possible that younger sepsis survivors may have undergone surgical limb amputation to facilitate rehabilitation and return to work. CRRT is usually used to treat sepsis-associated acute kidney injury [30]; its use indicates that patients treated with CRRT may have had a more severe status than other patients with sepsis not requiring CRRT treatment. Therefore, CRRT was not a causal factor but rather an associated factor for both the development of PG and limb amputation.…”