TY - JOUR
T1 - Sepsis-Associated Acute Kidney Disease
AU - ProCESS and ProGReSS-AKI Investigators
AU - Peerapornratana, Sadudee
AU - Priyanka, Priyanka
AU - Wang, Shu
AU - Smith, Ali
AU - Singbartl, Kai
AU - Palevsky, Paul M.
AU - Chawla, Lakhmir S.
AU - Yealy, Donald M.
AU - Angus, Derek C.
AU - Kellum, John A.
AU - Huang, David T.
AU - Keener, Christopher
AU - Lucko, Nicole
AU - Pike, Francis
AU - Yende, Sachin
AU - Barnato, Amber E.
AU - Eaton, Tammy L.
AU - Gimbel, Elizabeth
AU - Landis, Kyle
AU - Stapleton, Diana K.
AU - Weissfeld, Lisa A.
AU - Willochell, Michael
AU - Wofford, Kourtney A.
AU - Kulstad, Erik
AU - Watts, Hannah
AU - Venkatv, Arvind
AU - Hou, Peter C.
AU - Massaro, Anthony
AU - Parmar, Siddharth
AU - Limkakeng, Alexander T.
AU - Brewer, Kori
AU - Delbridge, Theodore R.
AU - Mainhart, Allison
AU - Miner, James R.
AU - Allen, Todd L.
AU - Grissom, Colin K.
AU - Swadron, Stuart
AU - Conrad, Steven A.
AU - Carlson, Richard
AU - LoVecchio, Frank
AU - Bajwa, Ednan K.
AU - Filbin, Michael R.
AU - Parry, Blair A.
AU - Ellender, Timothy J.
AU - Sama, Andrew E.
AU - Fine, Jonathan
AU - Nafeei, Soheil
AU - Terndrup, Thomas
AU - Wojnar, Margaret
AU - Pearl, Ronald G.
N1 - Publisher Copyright:
© 2020 International Society of Nephrology
PY - 2020/6
Y1 - 2020/6
N2 - Introduction: About one-third of critically ill patients with acute kidney injury (AKI) develop persistently decreased kidney function, known as acute kidney disease (AKD), which may progress to chronic kidney disease (CKD). Although sepsis is the most common cause of AKI, little is known about sepsis-associated AKD. Methods: Using data from a large randomized trial including 1341 patients with septic shock, we studied patients with stage 2 or 3 AKI on day 1 of hospitalization. We defined AKD as a persistently reduced glomerular filtration rate for >7 days. In addition to clinical data, we measured several urinary biomarkers (tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2∗IGFBP7], neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], liver-type fatty acid binding protein, and type 4 collagen) at 0, 6, and 24 hours, to predict AKD. Results: Of 598 patients, 119 (19.9%) died within 7 days, 318 (53.2%) had early reversal of AKI within the first 7 days, whereas 161 (26.9%) developed AKD. In patients with early reversal, 45 (14.2%) had relapsed AKI after early reversal, and only about one-third of these recovered. Among patients developing AKD, only 15 (9.3%) recovered renal function prior to discharge. Male sex, African American race, and underlying CKD were more predominant in patients developing AKD. None of the biomarkers tested performed well for prediction of AKD, although NGAL modestly increased the performance of a clinical model. Conclusions: AKD is common in patients with septic shock, especially among African American males and those with underlying CKD. Existing AKI biomarkers have limited utility for predicting AKD but might be useful together with clinical variables. Novel predictive biomarkers for renal recovery are needed.
AB - Introduction: About one-third of critically ill patients with acute kidney injury (AKI) develop persistently decreased kidney function, known as acute kidney disease (AKD), which may progress to chronic kidney disease (CKD). Although sepsis is the most common cause of AKI, little is known about sepsis-associated AKD. Methods: Using data from a large randomized trial including 1341 patients with septic shock, we studied patients with stage 2 or 3 AKI on day 1 of hospitalization. We defined AKD as a persistently reduced glomerular filtration rate for >7 days. In addition to clinical data, we measured several urinary biomarkers (tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2∗IGFBP7], neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], liver-type fatty acid binding protein, and type 4 collagen) at 0, 6, and 24 hours, to predict AKD. Results: Of 598 patients, 119 (19.9%) died within 7 days, 318 (53.2%) had early reversal of AKI within the first 7 days, whereas 161 (26.9%) developed AKD. In patients with early reversal, 45 (14.2%) had relapsed AKI after early reversal, and only about one-third of these recovered. Among patients developing AKD, only 15 (9.3%) recovered renal function prior to discharge. Male sex, African American race, and underlying CKD were more predominant in patients developing AKD. None of the biomarkers tested performed well for prediction of AKD, although NGAL modestly increased the performance of a clinical model. Conclusions: AKD is common in patients with septic shock, especially among African American males and those with underlying CKD. Existing AKI biomarkers have limited utility for predicting AKD but might be useful together with clinical variables. Novel predictive biomarkers for renal recovery are needed.
KW - acute kidney disease
KW - acute kidney injury
KW - biomarker
KW - predict
KW - recovery
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85085135331&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2020.03.005
DO - 10.1016/j.ekir.2020.03.005
M3 - Article
AN - SCOPUS:85085135331
SN - 2468-0249
VL - 5
SP - 839
EP - 850
JO - Kidney International Reports
JF - Kidney International Reports
IS - 6
ER -