The effect of continuous renal replacement therapy to treat sepsis associated acute kidney injury in very elderly patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

MA Guanhua , LI Xiangyang , ZHOU Yinan , GONG Jin , PU Jin ,  ZHU Huili

Department of Respiratory Medicine and Critical Care Medicine, Huadong Hospital, Shanghai Fudan University, Shanghai 200040, P. R. China;

Corresponding?author：

ZHU Huili, Email: zhuhuili001@126.com

Keywords：

Sepsis; Acute kidney injury; The oldest old; Continuous renal replacement therapy; Inflammations

DOI：

10.7507/1671-6205.201812047

Video：

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Objective To explore the effect of continuous renal replacement therapy (CRRT) to treat sepsis associated acute kidney injury (AKI) in patients aged over 80.Methods Forty-one patients diagnosed with sepsis and AKI were enrolled in geriatric RICU department of Huadong Hospital from January 2013 to July 2018, 38 patients were male and 3 were female. All patients were treated with anti-infection and fluid resuscitation therapy. After comprehensive judgment of the indication of renal replacement, they were divided into two groups by the choices of using CRRT. There were 20 patients in CRRT group and 21 in control group. Clinical data such as age, body mass index, previous diseases, 28-day mortality rate, blood cells, APACHEⅡ as well as SOFA scores were compared between two groups. Blood renal function and inflammatory markers at the first day were also compared to those after 3-day treatment of initial time.Results No statistical difference was observed in sex ratio, age, body mass index and previous diseases between two groups (all P>0.05). There was also no difference in APACHEⅡ score, SOFA score, blood cells, hemoglobin and survival time. The 28-day mortality rate in CRRT group was lower than that in control group (P<0.05). The levels of serum UA and C reactive protein (CRP) in CRRT group decreased after 3-day treatment compared with those at the onset, and the differences were statistically significant (all P<0.05). The level of serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA) and cystain C in control group increased after 3 days compared with those at the onset, and the difference were statistically significant (all P<0.05). There was no significant difference in serum BUN, Cr, UA, cystain C, CRP and procalcitonin (PCT) between two groups at the onset (all P>0.05). After 3 days of CRRT, the levels of serum PCT, BUN, Cr and UA in CRRT group were lower than those in the control group (all P<0.05).Conclusion CRRT can improve hyperuricemia, control deterioration of renal function, reduce early systemic inflammatory response and 28-day mortality rate in aged patients with sepsis and AKI.

Citation： MA Guanhua, LI Xiangyang, ZHOU Yinan, GONG Jin, PU Jin, ZHU Huili. The effect of continuous renal replacement therapy to treat sepsis associated acute kidney injury in very elderly patients. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 463-466. doi: 10.7507/1671-6205.201812047 Copy

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2.	Kumar G, Kumar N, Taneja A, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest, 2011, 140(5): 1223-1231.
3.	Mehta RL, Bouchard J, Soroko SB, et al. Sepsis as a cause and consequence of acute kidney injury: program to improve care in acute renal disease. Intensive Care Med, 2011, 37(2): 241-248.
4.	Neri M, Villa G, Garzotto F, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care, 2016, 20(1): 318.
5.	Ronco C, Bellomo R. Continuous renal replacement therapy: evolution in technology and current nomenclature. Kidney Int Suppl, 1998, 66: S160-S164.
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9.	Chronopoulos A, Rosner MH, Cruz DN, et al. Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med, 2010, 36(9): 1454-1464.
10.	Peters E, Antonelli M, Wittebole X, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from The Intensive Care Over Nations audit. Crit Care, 2018, 22(1): 188.
11.	Prowle JR. Sepsis-associated AKI. Clin J Am Soc Nephrol, 2018, 13(2): 339-342.
12.	Li Q, Zhao M, Wang X. AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria. Clin Interv Aging, 2018, 13: 1151-1160.
13.	Chao CT, Hou CC, Wu VC, et al. The impact of dialysis-requiring acute kidney injury on long-term prognosis of patients requiring prolonged mechanical ventilation: nationwide population-based study. PLoS One, 2012, 7(12): e50675.
14.	Bagshaw SM, Laupland KB, Doig CJ, et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care, 2005, 9(6): R700-R709.
15.	McCullough PA, Kellum JA, Haase M, et al. Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol, 2013, 182: 82-98.
16.	Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol, 2018, 14(4): 217-230.
17.	Peng ZY, Zhou F, Kellum JA. Cross-species validation of cell cycle arrest markers for acute kidney injury in the rat during sepsis. Intensive Care Med Exp, 2016, 4(1): 12.
18.	Marengo M, Dellepiane S, Cantaluppi V. Extracorporeal treatments in patients with acute kidney injury and sepsis. Contrib Nephrol, 2017, 190: 1-18.
19.	Pohl J, Papathanasiou M, Heisler M, et al. Renal replacement therapy neutralizes elevated MIF levels in septic shock. J Intensive Care, 2016, 4: 39.
20.	Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet, 2000, 356(9223): 26-30.
21.	Borthwick EM, Hill CJ, Rabindranath KS, et al. High-volume haemofiltration for sepsis. Cochrane Database Syst Rev, 2017, 1: CD008075.

1. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med, 2006, 34(1): 15-21.
2. Kumar G, Kumar N, Taneja A, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest, 2011, 140(5): 1223-1231.
3. Mehta RL, Bouchard J, Soroko SB, et al. Sepsis as a cause and consequence of acute kidney injury: program to improve care in acute renal disease. Intensive Care Med, 2011, 37(2): 241-248.
4. Neri M, Villa G, Garzotto F, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care, 2016, 20(1): 318.
5. Ronco C, Bellomo R. Continuous renal replacement therapy: evolution in technology and current nomenclature. Kidney Int Suppl, 1998, 66: S160-S164.
6. 中華醫學會重癥醫學分會. 中國嚴重膿毒癥/膿毒性休克治療指南(2014). 中華內科雜志, 2015, 54(6): 557-581.
7. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl, 2012, 2: 1-138.
8. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med, 2017, 45(3): 486-552.
9. Chronopoulos A, Rosner MH, Cruz DN, et al. Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med, 2010, 36(9): 1454-1464.
10. Peters E, Antonelli M, Wittebole X, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from The Intensive Care Over Nations audit. Crit Care, 2018, 22(1): 188.
11. Prowle JR. Sepsis-associated AKI. Clin J Am Soc Nephrol, 2018, 13(2): 339-342.
12. Li Q, Zhao M, Wang X. AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria. Clin Interv Aging, 2018, 13: 1151-1160.
13. Chao CT, Hou CC, Wu VC, et al. The impact of dialysis-requiring acute kidney injury on long-term prognosis of patients requiring prolonged mechanical ventilation: nationwide population-based study. PLoS One, 2012, 7(12): e50675.
14. Bagshaw SM, Laupland KB, Doig CJ, et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care, 2005, 9(6): R700-R709.
15. McCullough PA, Kellum JA, Haase M, et al. Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol, 2013, 182: 82-98.
16. Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol, 2018, 14(4): 217-230.
17. Peng ZY, Zhou F, Kellum JA. Cross-species validation of cell cycle arrest markers for acute kidney injury in the rat during sepsis. Intensive Care Med Exp, 2016, 4(1): 12.
18. Marengo M, Dellepiane S, Cantaluppi V. Extracorporeal treatments in patients with acute kidney injury and sepsis. Contrib Nephrol, 2017, 190: 1-18.
19. Pohl J, Papathanasiou M, Heisler M, et al. Renal replacement therapy neutralizes elevated MIF levels in septic shock. J Intensive Care, 2016, 4: 39.
20. Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet, 2000, 356(9223): 26-30.
21. Borthwick EM, Hill CJ, Rabindranath KS, et al. High-volume haemofiltration for sepsis. Cochrane Database Syst Rev, 2017, 1: CD008075.

Chinese Journal of Respiratory and Critical Care Medicine

The effect of continuous renal replacement therapy to treat sepsis associated acute kidney injury in very elderly patients

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