Oliguria in critically ill patients: a narrative review

Klein, Sebastian; Lehner, Georg; Forni, Lui G.; Joannidis, Michael

doi:10.1007/s40620-018-0539-6

Cited by 45 publications

(28 citation statements)

References 54 publications

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“…AKI is frequently characterized by oliguria, leading to fluid retention [31]. Patients with normal or impaired cardiac function may develop low pressure pulmonary oedema due to capillary leaking associated with systemic inflammation in AKI or ARF/ARDS, which is aggravated by fluid overload [32].…”

Section: Rationalementioning

confidence: 99%

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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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Section: Rationalementioning

confidence: 99%

“…Haemolysis and increased load of filtered pigment (e.g. myoglobin, CK) may result from muscle damage due to local ischaemia during ECMO [31,110]. Also, raised levels of proinflammatory cytokines (e.g.…”

Section: Rationalementioning

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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“…Continuous bumetanide infusion may be used off-label to promote urine output response in patients with heart failure or volume overload. Moreover, it is encouraged to maintain urine output response above 2 mL/kg/hour in oliguric patients 7 In conclusion, continuous bumetanide infusion may be used in the treatment of acute heart failure or volume overload to achieve goal urine output with close monitoring for new-onset or worsening AKI. However, the efficacy and safety of continuous bumetanide infusion should be demonstrated in larger-scale clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of bumetanide continuous infusion: A systematic review and meta‐analysis

et al. 2020

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The clinical use of continuous bumetanide infusion for acute heart failure and volume overload is common. However, there is not enough supporting evidence for the use of continuous bumetanide infusion. Thus, we conducted this systematic review and meta‐analysis aiming to describe the treatment outcomes of continuous bumetanide infusion. We searched Ovid MEDLINE, EMBASE and the Cochrane Library for eligible publications. Inclusion criteria were patients age ≥18 years with bumetanide infusion for heart failure, acute kidney injury (AKI) or volume overload. From 1564 citations, three studies (n = 94 patients) were included in the systematic review and meta‐analysis. The mean dose of bumetanide was 1.08 ± 0.43 mg/hour with a mean treatment duration of 45.09 ± 10.12 hours. Mean urine output in response to continuous bumetanide infusion was 1.88 mL/kg/hour (95% confidence interval [CI], 1.72‐2.05). The incidence of AKI with continuous bumetanide infusion was 24.7% (95% CI, 8.2‐54.6). By using Pearson's correlation coefficient, increasing doses of bumetanide were correlated with increased urine output (P = .026) and increased incidence of AKI (P < .01). There was no correlation between increasing urine output and the incidence of AKI (P = .739). In conclusion, with available evidence, continuous bumetanide infusion may be used in the treatment of acute heart failure or volume overload with close monitoring for new‐onset or worsening AKI.

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“…Limited data suggest AKI promotes neutrophil dysfunction, causing reduced clearance of infection and increasing lung permeability[ 54 , 55 ]. Haemodynamically, the inflammatory state and increased alveolar-capillary permeability combined with decreased urine output in AKI worsens pulmonary oedema[ 56 , 57 ]. Most immunological studies are based on animal models, however, observational data support the negative impact of AKI on pulmonary outcomes in critically ill patients, with two times more requiring invasive mechanical ventilation[ 58 , 59 ].…”

Section: Main Bodymentioning

confidence: 99%

Kidney injury in COVID-19

Ahmed¹,

Ebad²,

Stoneman³

et al. 2020

WJN

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Coronavirus disease 2019 (COVID-19) continues to affect millions of people around the globe. As data emerge, it is becoming more evident that extrapulmonary organ involvement, particularly the kidneys, highly influence mortality. The incidence of acute kidney injury has been estimated to be 30% in COVID-19 non-survivors. Current evidence suggests four broad mechanisms of renal injury: Hypovolaemia, acute respiratory distress syndrome related, cytokine storm and direct viral invasion as seen on renal autopsy findings. We look to critically assess the epidemiology, pathophysiology and management of kidney injury in COVID-19.

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Oliguria in critically ill patients: a narrative review

Cited by 45 publications

References 54 publications

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

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

Treatment outcomes of bumetanide continuous infusion: A systematic review and meta‐analysis

Kidney injury in COVID-19

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