Keywords
Sepsis-related acute kidney injury
Continuous renal replacement therapy (CRRT)
Timing of initiation
Submitted : 2024-08-08
Accepted : 2024-08-23
Published : 2024-09-07
Abstract
This review examines the application of continuous renal replacement therapy (CRRT) in patients with sepsis-associated acute kidney injury (S-AKI), with a particular focus on the timing of CRRT initiation. This review addresses the controversy surrounding initiation timing and proposes future research directions. Through a systematic review of recent literature on CRRT for S-AKI, working principles, therapeutic mechanisms, initiation timing of CRRT, and related meta-analyses were summarized. Current studies indicate that the optimal timing for CRRT initiation in S-AKI patients remains inconclusive, with ongoing debate regarding whether early initiation significantly improves patient survival and renal function. This lack of consensus reflects the heterogeneity of the S-AKI patient population and the limitations of existing research methodologies. Future studies should focus on advancing the application of precision medicine in S-AKI and developing individualized treatment strategies by integrating multidimensional information to optimize CRRT utilization and improve patient outcomes.
References
Singer M, Deutschman CS, Seymour CW, et al., 2016, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8): 801–810. https://doi.org/10.1001/jama.2016.0287
Pinheiro KHE, Azêdo FA, Areco KCN, et al., 2019, Risk Factors and Mortality in Patients with Sepsis, Septic and Non Septic Acute Kidney Injury in ICU. J Bras Nefrol, 41(4): 462–471. https://doi.org/10.1590/2175-8239-JBN-2018-0240
Bellomo R, Kellum JA, Ronco C, et al., 2017, Acute Kidney Injury in Sepsis. Intensive Care Med, 43(6): 816–828. https://doi.org/10.1007/s00134-017-4755-7
Uchino S, Kellum JA, Bellomo R, et al., 2005, Acute Renal Failure in Critically Ill Patients: A Multinational, Multicenter Study. JAMA, 294(7): 813–818. https://doi.org/10.1001/jama.294.7.813
Bagshaw SM, Lapinsky S, Dial S, et al., 2009, Acute Kidney Injury in Septic Shock: Clinical Outcomes and Impact of Duration of Hypotension Prior to Initiation of Antimicrobial Therapy. Intensive Care Med, 35(5): 871–881. https://doi.org/10.1007/s00134-008-1367-2
Kellum JA, Chawla LS, Keener C, et al., 2016, The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock. Am J Respir Crit Care Med, 193(3): 281–287. https://doi.org/10.1164/rccm.201505-0995OC
Wald R, Quinn RR, Luo J, et al., 2009, Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis. JAMA, 302(11): 1179–1185. https://doi.org/10.1001/jama.2009.1322. Erratum in JAMA, 302(14): 1532.
Bagshaw SM, Uchino S, Bellomo R, et al., 2007, Septic Acute Kidney Injury in Critically Ill Patients: Clinical Characteristics and Outcomes. Clin J Am Soc Nephrol, 2(3): 431–439. https://doi.org/10.2215/CJN.03681106
Ronco C, Ricci Z, 2008, Renal Replacement Therapies: Physiological Review. Intensive Care Med, 34(12): 2139–2146. https://doi.org/10.1007/s00134-008-1258-6
Karkar A, Ronco C, 2020, Prescription of CRRT: A Pathway to Optimize Therapy. Ann Intensive Care, 10(1): 32. https://doi.org/10.1186/s13613-020-0648-y
Fathima N, Kashif T, Janapala RN, et al., 2019, Single-best Choice Between Intermittent Versus Continuous Renal Replacement Therapy: A Review. Cureus, 11(9): e5558. https://doi.org/10.7759/cureus.5558
Hoste EA, Bagshaw SM, Bellomo R, et al., 2015, Epidemiology of Acute Kidney Injury in Critically Ill Patients: The Multinational AKI-EPI Study. Intensive Care Med, 41(8): 1411–1423. https://doi.org/10.1007/s00134-015-3934-7
Hanafusa N, 2015, Application of Continuous Renal Replacement Therapy: What Should We Consider Based on Existing Evidence? Blood Purif, 40(4): 312–319. https://doi.org/10.1159/000441579
Wang G, He Y, Guo Q, et al., 2023, Continuous Renal Replacement Therapy with the Adsorptive oXiris Filter May be Associated with the Lower 28-Day Mortality in Sepsis: A Systematic Review and Meta-Analysis. Crit Care, 27(1): 275. https://doi.org/10.1186/s13054-023-04555-x
Manrique-Caballero CL, Del Rio-Pertuz G, Gomez H, 2021, Sepsis-Associated Acute Kidney Injury. Crit Care Clin, 37(2): 279–301. https://doi.org/10.1016/j.ccc.2020.11.010
He FF, Wang YM, Chen YY, et al., 2022, Sepsis-Induced AKI: From Pathogenesis to Therapeutic Approaches. Front Pharmacol, 13: 981578. https://doi.org/10.3389/fphar.2022.981578
Zarbock A, Gomez H, Kellum JA, 2014, Sepsis-Induced Acute Kidney Injury Revisited: Pathophysiology, Prevention and Future Therapies. Curr Opin Crit Care, 20(6): 588–595. https://doi.org/10.1097/MCC.0000000000000153
Zarbock A, Koyner JL, Gomez H, et al., 2023, Sepsis-Associated Acute Kidney Injury-Treatment Standard. Nephrol Dial Transplant, 39(1): 26–35. https://doi.org/10.1093/ndt/gfad142. Erratum in Nephrol Dial Transplant, 38(12): 2858. https://doi.org/10.1093/ndt/gfad198
Zarbock A, Nadim MK, Pickkers P, et al., 2023, Sepsis-Associated Acute Kidney Injury: Consensus Report of the 28th Acute Disease Quality Initiative Workgroup. Nat Rev Nephrol, 19(6): 401–417. https://doi.org/10.1038/s41581-023-00683-3
Xu J 2023, A Review: Continuous Renal Replacement Therapy for Sepsis-Associated Acute Kidney Injury. All Life, 16(1): 2163305.
Zhang J, Tian J, Sun H, et al., 2018, How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury? Blood Purif, 46(4): 326–331. https://doi.org/10.1159/000492026
Li X, Mu G, Song C, et al., 2018, Role of M2 Macrophages in Sepsis-Induced Acute Kidney Injury. Shock, 50(2): 233–239. https://doi.org/10.1097/SHK.0000000000001006
New AM, Nystrom EM, Frazee E, et al., 2017, Continuous Renal Replacement Therapy: A Potential Source of Calories in the Critically Ill. Am J Clin Nutr, 105(6): 1559–1563. https://doi.org/10.3945/ajcn.116.139014
Onichimowski D, Goraj R, Jalali R, et al., 2017, Practical Issues of Nutrition During Continuous Renal Replacement Therapy. Anaesthesiol Intensive Ther, 49(4): 309–316. https://doi.org/10.5603/AIT.a2017.0052
Yamakawa K, Umemura Y, Hayakawa M, et al., 2016, Benefit Profile of Anticoagulant Therapy in Sepsis: A Nationwide Multicentre Registry in Japan. Crit Care, 20(1): 229. https://doi.org/10.1186/s13054-016-1415-1
Jing F, Li M, Ren H, et al., 2016, Effects of Atorvastatin Combined with Low-Molecular-Weight Heparin on Plasma Inflammatory Cytokine Level and Pulmonary Pathophysiology of Rats with Sepsis. Exp Ther Med, 12(2): 1048–1054. https://doi.org/10.3892/etm.2016.3372
Gautam SC, Lim J, Jaar BG, 2022, Complications Associated with Continuous RRT. Kidney360, 3(11): 1980–1990. https://doi.org/10.34067/KID.0000792022
Clark E, Wald R, Walsh M, et al., 2012, Timing of Initiation of Renal Replacement Therapy for Acute Kidney Injury: A Survey of Nephrologists and Intensivists in Canada. Nephrol Dial Transplant, 27(7): 2761–2767. https://doi.org/10.1093/ndt/gfr740
Ostermann M, Wald R, Bagshaw SM, 2016, Timing of Renal Replacement Therapy in Acute Kidney Injury. Contrib Nephrol, 187: 106–120. https://doi.org/10.1159/000442369
An JN, Kim SG, Song YR, 2021, When and Why to Start Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury. Kidney Res Clin Pract, 40(4): 566–577. https://doi.org/10.23876/j.krcp.21.043
Oh HJ, Shin DH, Lee MJ, et al., 2012, Early Initiation of Continuous Renal Replacement Therapy Improves Patient Survival in Severe Progressive Septic Acute Kidney Injury. J Crit Care, 27(6): 743.e9–18. https://doi.org/10.1016/j.jcrc.2012.08.001
Fan Y, Chen L, Jiang S, et al., 2022, Timely Renal Replacement Therapy Linked to Better Outcome in Patients with Sepsis-Associated Acute Kidney Injury. J Intensive Med, 2(3): 173–182. https://doi.org/10.1016/j.jointm.2022.03.004
An N, Chen R, Bai Y, et al., 2021, Efficacy and Prognosis of Continuous Renal Replacement Therapy at Different Times in the Treatment of Patients with Sepsis-Induced Acute Kidney Injury. Am J Transl Res, 13(6): 7124–7131.
Zarbock A, Kellum JA, Schmidt C, et al., 2016, Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial. JAMA, 315(20): 2190–2199. https://doi.org/10.1001/jama.2016.5828
Barbar SD, Clere-Jehl R, Bourredjem A, et al., 2018, Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med, 379(15): 1431–1442. https://doi.org/10.1056/NEJMoa1803213
Gaudry S, Hajage D, Schortgen F, et al., 2016, Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med, 375(2): 122–133. https://doi.org/10.1056/NEJMoa1603017
Gaudry S, Hajage D, Benichou N, et al., 2020, Delayed Versus Early Initiation of Renal Replacement Therapy for Severe Acute Kidney Injury: A Systematic Review and Individual Patient Data Meta-Analysis of Randomised Clinical Trials. Lancet, 395(10235): 1506–1515. https://doi.org/10.1016/S0140-6736(20)30531-6
Li X, Liu C, Mao Z, et al., 2021, Timing of Renal Replacement Therapy Initiation for Acute Kidney Injury in Critically Ill Patients: A Systematic Review of Randomized Clinical Trials with Meta-Analysis and Trial Sequential Analysis. Crit Care, 25(1): 15. https://doi.org/10.1186/s13054-020-03451-y
Xia ZJ, He LY, Pan SY, et al., 2021, Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis. Front Med (Lausanne), 8: 580144. https://doi.org/10.3389/fmed.2021.580144
Pan HC, Chen YY, Tsai IJ, et al., 2021, Accelerated Versus Standard Initiation of Renal Replacement Therapy for Critically Ill Patients with Acute Kidney Injury: A Systematic Review and Meta-Analysis of RCT Studies. Crit Care, 25(1): 5. https://doi.org/10.1186/s13054-020-03434-z
Birkelo BC, Koyner JL, Ostermann M, et al., 2024, The Road to Precision Medicine for Acute Kidney Injury. Crit Care Med, 52(7): 1127–1137. https://doi.org/10.1097/CCM.0000000000006328
Ostermann M, Zarbock A, Goldstein S, et al., 2020, Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Netw Open, 3(10): e2019209. https://doi.org/10.1001/jamanetworkopen.2020.19209. Erratum in JAMA Netw Open, 3(11): e2029182. https://doi.org/10.1001/jamanetworkopen.2020.29182
Schunk SJ, Speer T, Petrakis I, et al., 2021, Dickkopf 3 – A Novel Biomarker of the ‘Kidney Injury Continuum’. Nephrol Dial Transplant, 36(5): 761–767. https://doi.org/10.1093/ndt/gfaa003
Haase M, Devarajan P, Haase-Fielitz A, et al., 2011, The Outcome of Neutrophil Gelatinase-Associated Lipocalin-Positive Subclinical Acute Kidney Injury: A Multicenter Pooled Analysis of Prospective Studies. J Am Coll Cardiol, 57(17): 1752–1761. https://doi.org/10.1016/j.jacc.2010.11.051
Chaudhary K, Vaid A, Duffy Á, et al., 2020, Utilization of Deep Learning for Subphenotype Identification in Sepsis-Associated Acute Kidney Injury. Clin J Am Soc Nephrol, 15(11): 1557–1565. https://doi.org/10.2215/CJN.09330819
Hansen J, Sealfon R, Menon R, et al., 2022, A Reference Tissue Atlas for the Human Kidney. Sci Adv, 8(23): eabn4965. https://doi.org/10.1126/sciadv.abn4965