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Sepsis-Associated Acute Kidney Disease
Sadudee Peerapornratana1,2,3,4,5, Priyanka Priyanka1, Shu Wang1,6,7
1Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Kidney International Reports
|June 11, 2020
Summary
Acute kidney disease (AKD) is common in septic shock patients, particularly African American males and those with chronic kidney disease (CKD). Current biomarkers poorly predict AKD, highlighting the need for new predictive tools.
Area of Science:
- Nephrology
- Critical Care Medicine
- Sepsis Research
Background:
- Acute kidney injury (AKI) affects one-third of critically ill patients, with a subset progressing to acute kidney disease (AKD).
- Sepsis is a leading cause of AKI, yet sepsis-associated AKD remains poorly understood.
- AKD can lead to chronic kidney disease (CKD), necessitating research into its development and prediction.
Purpose of the Study:
- To investigate the incidence and predictors of acute kidney disease (AKD) in patients with septic shock.
- To evaluate the utility of urinary biomarkers in predicting AKD development.
- To identify patient characteristics associated with AKD in the context of sepsis.
Main Methods:
- Analysis of data from a randomized trial of 1341 patients with septic shock.
- Inclusion of 598 patients with stage 2 or 3 acute kidney injury (AKI) on day 1.
- Definition of AKD as persistently reduced glomerular filtration rate (>7 days) and measurement of urinary biomarkers (TIMP-2*IGFBP7, NGAL, KIM-1, etc.) at multiple time points.
Main Results:
- 161 (26.9%) of 598 patients developed AKD; only 9.3% recovered renal function before discharge.
- Male sex, African American race, and pre-existing CKD were more common in patients with AKD.
- Urinary biomarkers showed limited predictive performance for AKD, though NGAL improved a clinical model's accuracy.
Conclusions:
- Acute kidney disease (AKD) is a frequent complication of septic shock, disproportionately affecting African American males and individuals with CKD.
- Current AKI biomarkers have limited value for predicting AKD, emphasizing the need for novel predictive markers.
- Integrated clinical and biomarker approaches may improve AKD prediction, but new biomarkers for renal recovery are essential.
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