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Observational Study
. 2013 Nov 29;17(6):R278.
doi: 10.1186/cc13133.

Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study

Matthieu Legrand, Claire Dupuis, Christelle Simon, Etienne Gayat, Joaquim Mateo, Anne-Claire Lukaszewicz, Didier Payen
Observational Study

Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study

Matthieu Legrand et al. Crit Care. .

Abstract

Introduction: The role of systemic hemodynamics in the pathogenesis of septic acute kidney injury (AKI) has received little attention. The purpose of this study was to investigate the association between systemic hemodynamics and new or persistent of AKI in severe sepsis.

Methods: A retrospective study between 2006 and 2010 was performed in a surgical ICU in a teaching hospital. AKI was defined as development (new AKI) or persistent AKI during the five days following admission based on the Acute Kidney Injury Network (AKIN) criteria. We studied the association between the following hemodynamic targets within 24 hours of admission and AKI: central venous pressure (CVP), cardiac output (CO), mean arterial pressure (MAP), diastolic arterial pressure (DAP), central venous oxygen saturation (ScvO2) or mixed venous oxygen saturation (SvO2).

Results: This study included 137 ICU septic patients. Of these, 69 had new or persistent AKI. AKI patients had a higher Simplified Acute Physiology Score (SAPS II) (57 (46 to 67) vs. 45 (33 to 52), P < 0.001) and higher mortality (38% vs. 15%, P = 0.003) than those with no AKI or improving AKI. MAP, ScvO2 and CO were not significantly different between groups. Patients with AKI had lower DAP and higher CVP (P = 0.0003). The CVP value was associated with the risk of developing new or persistent AKI even after adjustment for fluid balance and positive end-expiratory pressure (PEEP) level (OR = 1.22 (1.08 to 1.39), P = 0.002). A linear relationship between CVP and the risk of new or persistent AKI was observed.

Conclusions: We observed no association between most systemic hemodynamic parameters and AKI in septic patients. Association between elevated CVP and AKI suggests a role of venous congestion in the development of AKI. The paradigm that targeting high CVP may reduce occurrence of AKI should probably be revised. Furthermore, DAP should be considered as a potential important hemodynamic target for the kidney.

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Figures

Figure 1
Figure 1
Flowchart of patients included in the study. AKI, acute kidney injury. CO, cardiac output; CVP, central venous pressure.
Figure 2
Figure 2
Statistical model of nonparametric logistic regression showing the relationship between mean central venous pressure during the first 24 hours after admission and the probability of new or persistent acute kidney injury. Note the plateau for the incidence of acute kidney injury (AKI) when the lower limit of central venous pressure (CVP) was between 8 and 12 mmHg. Over this limit, the rise in CVP was associated with a sharp increase in new or persistent AKI incidence.
Figure 3
Figure 3
Survival according to the occurrence of new or persistent acute kidney injury in survival according to the occurrence of AKI. AKI, acute kidney injury.
See this image and copyright information in PMC

Comment in

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