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Risk factors for chronic kidney disease and septic shock with hypertension in adults and children
R Mohamad Javier1, Jonathan Salim2, Bethari Lekso Aji3
1Department of Cardiology and Vascular Medicine, Universitas Indonesia Hospital, Depok, Java, Indonesia.
Insights
Chronic kidney disease (CKD) and hypertension are major risk factors for sepsis-associated acute kidney injury (AKI). Early intervention and tailored fluid strategies are crucial for improving outcomes in both adults and children with these conditions.
Area of Science:
- Nephrology
- Critical Care Medicine
- Pediatrics
Background:
- Chronic kidney disease (CKD) affects 10% of the global population, often progressing to end-stage renal disease.
- Hypertension is a primary driver of CKD progression in adults and children.
- Sepsis-associated acute kidney injury (AKI) significantly increases long-term renal dysfunction risk, especially in CKD patients.
Purpose of the Study:
- To systematically evaluate research on risk factors for CKD and septic shock in hypertensive adults and children.
- To characterize the interplay between CKD, hypertension, and septic shock outcomes.
- To identify key risk factors and effective management strategies for sepsis-induced AKI.
Main Methods:
- A systematic literature search was performed in PubMed, Google Scholar, and Cochrane Library (2004-2024).
- Search terms included "chronic kidney disease," "septic shock," "hypertension," and "acute kidney injury."
- Nine studies were included for qualitative synthesis following PRISMA guidelines.
Main Results:
- CKD and hypertension are independent risk factors for sepsis-associated AKI and septic shock.
- Poor outcomes were linked to albuminuria, uncontrolled blood pressure, advanced age, and diabetes.
- Pediatric AKI history correlated with new-onset hypertension and CKD, increasing sepsis vulnerability.
Conclusions:
- CKD and hypertension exacerbate septic complications and worsen renal outcomes, particularly with fluid management issues.
- Individualized hemodynamic targets and fluid resuscitation are critical for reducing mortality.
- Long-term surveillance and early intervention are vital for pediatric patients with CKD and hypertension.
Background:
Chronic kidney disease (CKD) affects nearly 10% of the global population and often progresses silently to end-stage renal disease, requiring dialysis or transplantation. Hypertension, prevalent in both adults and children, is a key driver of CKD progression. Acute kidney injury (AKI), particularly sepsis-associated AKI (S-AKI), poses a critical risk for long-term renal dysfunction, especially in patients with pre-existing CKD. S-AKI, defined by abrupt renal function decline during sepsis or septic shock, can accelerate CKD progression, yet its risk factors and outcomes across pediatric and adult populations remain incompletely characterized.
Objective:
Aims to systematically evaluate existing research on the relationship between Risk Factors for CKD and Septic Shock with Hypertension in Adults and Children.
Methods:
A systematic literature search was conducted using PubMed, Google Scholar, and the Cochrane Library for studies published between 2004 and 2024. Search terms included "chronic kidney disease," "septic shock," "hypertension," and "acute kidney injury." After applying PRISMA-based screening and eligibility criteria, 9 studies were included for qualitative synthesis.
Results:
A total of 762 articles were identified through database searching. After screening and eligibility assessment, 9 studies were included in the final synthesis. The findings revealed that both CKD and hypertension are significant independent risk factors for S-AKI and septic shock. Preexisting albuminuria, uncontrolled blood pressure, advanced age, and diabetes mellitus were frequently associated with poor outcomes. Several studies highlighted the role of MPP and fluid resuscitation strategies in preventing AKI progression in septic patients. In pediatric populations, a history of AKI was strongly associated with new-onset hypertension and subsequent CKD development, increasing vulnerability to severe septic complications.
Conclusion:
CKD and hypertension significantly increase the risk of septic complications and worsen renal outcomes, particularly in patients with fluid management challenges. Early identification of high-risk patients, individualized hemodynamic targets, and tailored fluid resuscitation strategies are critical in reducing morbidity and mortality. Special attention is needed in pediatric patients with limited nephron reserve, where long-term surveillance and early intervention may improve outcomes.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/display_record.php, identifier PROSPERO (CRD420251146866).
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