Septic Acute Kidney Injury in Critically Ill Patients

Abstract

Sepsis is the most common cause of acute kidney injury (AKI) in critical illness, but there is limited information on septic AKI.A prospective, observational study of critically ill patients with septic and nonseptic AKI was performed from September 2000 to December 2001 at 54 hospitals in 23 countries. A total of 1753 patients were enrolled. Sepsis was considered the cause in 833 (47.5%); the predominant sources of sepsis were chest and abdominal (54.3%). Septic AKI was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. There was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (RRT; 72 versus 71%; P ‫؍‬ 0.83). Oliguria was more common in septic AKI (67 versus 57%; P < 0.001). Septic AKI had a higher in-hospital case-fatality rate compared with nonseptic AKI (70.2 versus 51.8%; P < 0.001). After adjustment for covariates, septic AKI remained associated with higher odds for death (1.48; 95% confidence interval 1.17 to 1.89; P ‫؍‬ 0.

Review article: Acute kidney injury in critical illness

“…43 These distinctions in pathophysiology may have clinical relevance, as septic patients show important differences in baseline demographics, acuity of illness, and treatment intensity when compared with non-septic AKI, such as older age, a higher burden of comorbid disease, and a higher likelihood for emergency surgical procedures, vasoactive support, and mechanical ventilation. 39,40 Observational data also suggest that delay to appropriate antimicrobials is an important independent factor associated with a higher risk for AKI. 51 Data from the BEST Kidney Study also revealed that 71% of patients with septic AKI required acute RRT, with 85% of patients receiving CRRT as initial therapy.…”

“…51 Data from the BEST Kidney Study also revealed that 71% of patients with septic AKI required acute RRT, with 85% of patients receiving CRRT as initial therapy. 40 When compared with either non-septic AKI or sepsis alone, several studies have confirmed that septic AKI portends higher adjusted risk of short-and long-term mortality and consumption of additional health resources. 17,[39][40][41]51 Interestingly; however, compared with non-septic AKI, survivors of septic may have a greater likelihood of renal recovery and independence from RRT.…”

“…40 When compared with either non-septic AKI or sepsis alone, several studies have confirmed that septic AKI portends higher adjusted risk of short-and long-term mortality and consumption of additional health resources. 17,[39][40][41]51 Interestingly; however, compared with non-septic AKI, survivors of septic may have a greater likelihood of renal recovery and independence from RRT. 40,52 Cardio-renal syndrome Kidney and cardiac disease are common, increasingly prevalent, and frequently co-exist.…”

“…17,[39][40][41]51 Interestingly; however, compared with non-septic AKI, survivors of septic may have a greater likelihood of renal recovery and independence from RRT. 40,52 Cardio-renal syndrome Kidney and cardiac disease are common, increasingly prevalent, and frequently co-exist. 53 Evidence has accrued to show that acute/chronic cardiac disease can contribute directly to acute/chronic worsening kidney function and vice versa.…”

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

“…Among the various etiologies of AKI, AKI arising from sepsis (sepsis‐induced AKI) most frequently occurs in patients requiring intensive care and is said to comprise 30%–70% of all cases of AKI 249. Other reports have also stated that sepsis‐induced AKI occurs in ~10%–20% of all intensive care unit (ICU) patients 250.…”