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Sepsis-Associated Acute Kidney Disease

Publication ,  Journal Article
Peerapornratana, S; Priyanka, P; Wang, S; Smith, A; Singbartl, K; Palevsky, PM; Chawla, LS; Yealy, DM; Angus, DC; Kellum, JA; Huang, DT ...
Published in: Kidney International Reports
June 1, 2020

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.

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Published In

Kidney International Reports

DOI

ISSN

2468-0249

Publication Date

June 1, 2020

Volume

5

Issue

6

Start / End Page

839 / 850

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

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Peerapornratana, S., Priyanka, P., Wang, S., Smith, A., Singbartl, K., Palevsky, P. M., … Migues, R. M. (2020). Sepsis-Associated Acute Kidney Disease. Kidney International Reports, 5(6), 839–850. https://doi.org/10.1016/j.ekir.2020.03.005
Peerapornratana, S., P. Priyanka, S. Wang, A. Smith, K. Singbartl, P. M. Palevsky, L. S. Chawla, et al. “Sepsis-Associated Acute Kidney Disease.” Kidney International Reports 5, no. 6 (June 1, 2020): 839–50. https://doi.org/10.1016/j.ekir.2020.03.005.
Peerapornratana S, Priyanka P, Wang S, Smith A, Singbartl K, Palevsky PM, et al. Sepsis-Associated Acute Kidney Disease. Kidney International Reports. 2020 Jun 1;5(6):839–50.
Peerapornratana, S., et al. “Sepsis-Associated Acute Kidney Disease.” Kidney International Reports, vol. 5, no. 6, June 2020, pp. 839–50. Scopus, doi:10.1016/j.ekir.2020.03.005.
Peerapornratana S, Priyanka P, Wang S, Smith A, Singbartl K, Palevsky PM, Chawla LS, Yealy DM, Angus DC, Kellum JA, Huang DT, Keener C, Lucko N, Pike F, Yende S, Barnato AE, Eaton TL, Gimbel E, Landis K, Stapleton DK, Weissfeld LA, Willochell M, Wofford KA, Kulstad E, Watts H, Venkatv A, Hou PC, Massaro A, Parmar S, Limkakeng AT, Brewer K, Delbridge TR, Mainhart A, Miner JR, Allen TL, Grissom CK, Swadron S, Conrad SA, Carlson R, LoVecchio F, Bajwa EK, Filbin MR, Parry BA, Ellender TJ, Sama AE, Fine J, Nafeei S, Terndrup T, Wojnar M, Pearl RG, Wilber ST, Sinert R, Orban DJ, Wilson JW, Ufberg JW, Albertson T, Panacek EA, Parekh S, Gunn SR, Rittenberger JS, Wadas RJ, Edwards AR, Kelly M, Wang HE, Holmes TM, McCurdy MT, Weinert C, Harris ES, Self WH, Dubinski D, Phillips CA, Migues RM. Sepsis-Associated Acute Kidney Disease. Kidney International Reports. 2020 Jun 1;5(6):839–850.
Journal cover image

Published In

Kidney International Reports

DOI

ISSN

2468-0249

Publication Date

June 1, 2020

Volume

5

Issue

6

Start / End Page

839 / 850

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences