Long-term mortality and risk factors for development of end-stage renal disease in critically ill patients with and without chronic kidney disease

Rimes-Stigare, Claire; Frumento, Paolo; Bottai, Matteo; Mårtensson, Johan; Martling, Claes‐Roland; Bell, Max

doi:10.1186/s13054-015-1101-8

Cited by 70 publications

(51 citation statements)

References 31 publications

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“…With an increased risk by as much as ten times, CKD is the major risk factor for AKI development [6,7], particularly among critically ill patients admitted in the ICU [3]. Although fluid overload and muscle wasting may affect the reliability of serum creatinine (sCr) values in diagnosing AKI and staging its severity in critically ill patients [8], a transient decrease in renal function, consistent with AKI, might be still recognized in most critically ill CKD patients.…”

Section: Pathophysiological Relationship Between Ckd and Akimentioning

confidence: 99%

“…Because of changes in patients demographic characteristics and availability of long-term renal replacement therapy (LT-RRT) during end-stage kidney disease (ESKD), the percentage of patients with preexisting renal dysfunction who develop acute critical illness, requiring admission in the intensive care unit (ICU), is progressively increased [3]. Nowadays, the management of ‘critically ill CKD patients' is a routine clinical challenge for nephrologists and intensivists.…”

Section: Introductionmentioning

confidence: 99%

“…The development of acute kidney injury (AKI) in CKD patients during acute illness is quite common (acute-on-chronic (AoC) kidney disease) and further worsens the patient outcome [3]. Nonetheless, for those patients who survived from critically ill AKI after an AoC episode, the risk for progression of the kidney dysfunction is high and frequently leads to ESKD [3].…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, for those patients who survived from critically ill AKI after an AoC episode, the risk for progression of the kidney dysfunction is high and frequently leads to ESKD [3]. The relationship among AKI, CKD and ESKD is highly complex.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, an adequate management of multi-organ damage of those kidney patients, thereby preventing the progression of kidney dysfunction during their critically illness is thus necessary [3]. …”

Section: Introductionmentioning

confidence: 99%

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Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Rosa

Samoni²,

Villa³

et al. 2017

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3,607

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Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). ‘Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD.

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Section: Pathophysiological Relationship Between Ckd and Akimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Rosa

Samoni²,

Villa³

et al. 2017

Blood Purif

3,607

View full text Add to dashboard Cite

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Metformin use is associated with reduced acute kidney injury following coronary artery bypass grafting in patients with type 2 diabetes: An inverse probability of treatment weighting analysis

et al. 2023

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Study ObjectiveAcute kidney injury (AKI) is a common and serious complication after coronary artery bypass grafting (CABG) surgery. Patients with diabetes are commonly associated with renal microvascular complications and have a greater risk of AKI after CABG surgery. This study aimed to explore whether preoperative metformin administration could reduce the incidence of postoperative AKI following CABG in patients with type 2 diabetes.DesignPatients with diabetes who underwent CABG were retrospectively included in this study. AKI after CABG was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The effects of metformin on postoperative AKI following CABG in patients were compared and analyzed.Data SourcePatients were enrolled in this study between January 2019 and December 2020 in Beijing Anzhen Hospital.PatientsA total of 812 patients were enrolled. The patients were divided into the metformin group (203 cases) and the control group (609 cases) according to whether metformin was used preoperatively.InterventionInverse probability of treatment weighting (IPTW) was applied to minimize baseline differences between the two groups. IPT‐weighted p values were analyzed to evaluate the postoperative outcomes between the two groups.Measurements and Main ResultsThe incidence of AKI in the metformin group and the control group was compared. After IPTW adjustment, the incidence of AKI in the metformin group was lower than the control group (IPTW‐adjusted p < 0.001). In the subgroup analysis, metformin showed significant protective effects in the estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2 and eGFR 60–90 mL/min per 1.73 m2 subgroups, which was not observed in the eGFR ≥90 mL/min per 1.73 m2 subgroup. No significant differences in the incidence of renal replacement therapy, reoperation due to bleeding, in‐hospital mortality, or red blood cell transfusion volume were observed between the two groups.ConclusionsIn this study, we provided evidence that preoperative metformin was associated with a significant reduction of postoperative AKI following CABG in patients with diabetes. Metformin showed significant protective effects in patients with mild‐to‐moderate renal insufficiency.

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Practical considerations for individualizing drug dosing in critically ill adults receiving renal replacement therapy

et al. 2023

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Critically ill patients with sepsis admitted to the intensive care unit (ICU) often present with or develop renal dysfunction requiring renal replacement therapy (RRT) in addition to antimicrobial therapy. While early and appropriate antimicrobials for sepsis have been associated with an increased probability of survival, adequate dosing is also required in these patients. Adequate dosing of antimicrobials refers to dosing strategies that achieve serum drug levels at the site of infection that are able to provide a microbiological and/or clinical response while avoiding toxicity from excessive antibiotic exposure. Therapeutic drug monitoring (TDM) is the recommended strategy to achieve this goal, however, TDM is not routinely available in all ICUs and for all antimicrobials. In the absence of TDM, clinicians are therefore required to make dosing decisions based on the clinical condition of the patient, the causative organism, the characteristics of RRT, and an understanding of the physicochemical properties of the antimicrobial. Pharmacokinetics (PK) of antimicrobials can be highly variable between critically ill patients and also within the same patient over the course of their ICU stay. The initiation of RRT, which can be in the form of intermittent hemodialysis, continuous, or prolonged intermittent therapy, further complicates the predictability of drug disposition. This variability highlights the need for individualized dosing. This review highlights the practical considerations for the clinician for antimicrobial dosing in critically ill patients receiving RRT.

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Long-term mortality and risk factors for development of end-stage renal disease in critically ill patients with and without chronic kidney disease

Cited by 70 publications

References 31 publications

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Metformin use is associated with reduced acute kidney injury following coronary artery bypass grafting in patients with type 2 diabetes: An inverse probability of treatment weighting analysis

Practical considerations for individualizing drug dosing in critically ill adults receiving renal replacement therapy

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