CRRT for sepsis-induced acute kidney injury

Stefano Romagnoli, Zaccaria Ricci, Claudio Ronco

Research output: Contribution to journalArticle

Abstract

PURPOSE OF REVIEW: Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between 'rescue' indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.

RECENT FINDINGS: Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.

SUMMARY: In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.

Original languageEnglish
Number of pages9
JournalCurrent Opinion in Critical Care
DOIs
Publication statusE-pub ahead of print - Sep 18 2018

Fingerprint

Renal Replacement Therapy
Acute Kidney Injury
Sepsis
Oliguria
Anuria
Kidney
Systemic Inflammatory Response Syndrome
Hyperkalemia
Uremia
Poisons
Acidosis
Renal Insufficiency
Inflammation
Equipment and Supplies
Membranes
Survival

Cite this

CRRT for sepsis-induced acute kidney injury. / Romagnoli, Stefano; Ricci, Zaccaria; Ronco, Claudio.

In: Current Opinion in Critical Care, 18.09.2018.

Research output: Contribution to journalArticle

@article{92e866b3e1ff4b2f964cc3b2145d5c67,
title = "CRRT for sepsis-induced acute kidney injury",
abstract = "PURPOSE OF REVIEW: Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between 'rescue' indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.RECENT FINDINGS: Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.SUMMARY: In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.",
author = "Stefano Romagnoli and Zaccaria Ricci and Claudio Ronco",
year = "2018",
month = "9",
day = "18",
doi = "10.1097/MCC.0000000000000544",
language = "English",
journal = "Current Opinion in Critical Care",
issn = "1070-5295",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - CRRT for sepsis-induced acute kidney injury

AU - Romagnoli, Stefano

AU - Ricci, Zaccaria

AU - Ronco, Claudio

PY - 2018/9/18

Y1 - 2018/9/18

N2 - PURPOSE OF REVIEW: Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between 'rescue' indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.RECENT FINDINGS: Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.SUMMARY: In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.

AB - PURPOSE OF REVIEW: Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between 'rescue' indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.RECENT FINDINGS: Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.SUMMARY: In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.

U2 - 10.1097/MCC.0000000000000544

DO - 10.1097/MCC.0000000000000544

M3 - Article

JO - Current Opinion in Critical Care

JF - Current Opinion in Critical Care

SN - 1070-5295

ER -