RESUMEN
Augmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimation formula and measured GFR. Observational, prospective, multicenter study. ARC was defined as a creatinine clearance greater than 130 ml/min/1.73 m2. Eighteen hospitals were recruited. GFR measurements carried out twice weekly during a 2-month follow-up period. A total of 561 patients were included. ARC was found to have a non-negligible prevalence of 30%. More even, up to 10.7% already had ARC at intensive care unit (ICU) admission. No specific pattern of GFR was found during the follow-up. Patients in the ARC group were younger 56.5 (53.5-58.5) versus 66 (63.5-68.5) years than in the non-ARC group, p < 0.001. ICU mortality was lower in the ARC group, 6.9% versus 14.5%, p = 0.003. There was no concordance between the estimation of GFR by the CKD-EPI formula and GFR calculated from the 4-h urine. ARC is found in up to 30% of ICU patients, so renal removal drugs could be under dosed by up to 30%. And ARC is already detected on admission in 10%. It is a dynamic phenomenon without an established pattern that usually occurs in younger patients that can last for several weeks. And the CKD-EPI formula does not work to estimate the real creatinine clearance of these patients.
Asunto(s)
Insuficiencia Renal Crónica , Creatinina , Femenino , Tasa de Filtración Glomerular , Humanos , Pruebas de Función Renal , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND: The impact of Surviving Sepsis Campaign (SSC) care bundles in reducing sepsis-associated acute kidney injury (SA-AKI) was evaluated. METHODS: We conducted an observational single-center cohort study. Accomplishment of SSC care bundles was registered in all patients with severe sepsis admitted to the critical care department of a university hospital during three different periods. The main outcome measured was SA-AKI incidence defined as any worsening of AKI stage within the first 7 days from onset of sepsis. RESULTS: Among 260 patients with severe sepsis or septic shock finally meeting inclusion criteria, 82 (31.5%) patients developed SA-AKI. None of the SSC care tasks significantly decreased SA-AKI incidence, although a trend was observed with an initial better blood glucose control as well as with a more protective ventilation strategy. Hypotension requiring fluid challenge (hazard ratio (HR), 2.3; 95% confidence interval (CI), 1.2 - 4.2) and the presence of an abdominal sepsis etiology (HR, 1.8; 95% CI, 1.1 - 3.1) were independently associated with SA-AKI. Patients who developed SA-AKI had a higher 90-day mortality rate (62.2 vs. 40.4%). CONCLUSION: In a cohort of septic patients, none of the SSC care tasks significantly decreased SA-AKI incidence within the first week after onset of sepsis.â©.
Asunto(s)
Lesión Renal Aguda/prevención & control , Paquetes de Atención al Paciente , Sepsis/complicaciones , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sepsis/mortalidad , Choque Séptico/complicaciones , Choque Séptico/mortalidadRESUMEN
PURPOSE: Identify clinical variables associated with mortality in patients with sepsis-associated acute kidney injury (SA-AKI) receiving continuous renal replacement therapy (CRRT) and examine timing of initiation of CRRT in reference to those variables identified. METHODS: Retrospective study conducted at two tertiary care hospitals including 939 septic shock patients with SA-AKI who received CRRT in the intensive care unit (ICU). Cox regression models were used to identify variables associated with 90-day mortality. Timing of CRRT initiation was assessed in relationship to significant clinical variables identified. RESULTS: Overall 90-day mortality was 62.9%. Variables prior to CRRT associated with 90-day mortality included: age (aHR, 1.02; 95%CI, 1.01-1.02, p<000.1), APS-III score (1.01, 1.0-1.0, p<0.048), days from hospital admission to CRRT initiation (1.01, 1.0-1.0, p<0.01), blood urea nitrogen (1.01, 1.0-1.0, p<0.04), medical admission (1.76, 1.5-2.1, p<0.0001), creatinine (0.99, 0.9-1.0, p<0.001), and urine output (0.77, 0.6-0.9, p=0.049). In patients with advanced SA-AKI at ICU admission receiving CRRT within the first 5days (n=433), urine output during the 24h prior to CRRT initiation was a strong predictor of survival (2.6, 1.6-4.3, p<0.001). CONCLUSIONS: In patients with SA-AKI, survival is lower when CRRT is started in the setting of low urine output.
Asunto(s)
Lesión Renal Aguda/terapia , Terapia de Reemplazo Renal/mortalidad , Sepsis/mortalidad , Lesión Renal Aguda/mortalidad , Anciano , Nitrógeno de la Urea Sanguínea , Creatinina/metabolismo , Cuidados Críticos/estadística & datos numéricos , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Diálisis Renal/mortalidad , Estudios Retrospectivos , Choque Séptico/complicaciones , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
No disponible