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Review
. 2023 Sep 3;27(1):341.
doi: 10.1186/s13054-023-04632-1.

Acute kidney injury in neurocritical care

Faeq Husain-Syed #  1   2 , Tomonori Takeuchi #  3   4 , Javier A Neyra  3 , Gonzalo Ramírez-Guerrero  5   6   7 , Mitchell H Rosner  1 , Claudio Ronco  8   9 , Ashita J Tolwani  10
Affiliations
Review

Acute kidney injury in neurocritical care

Faeq Husain-Syed et al. Crit Care. .

Abstract

Approximately 20% of patients with acute brain injury (ABI) also experience acute kidney injury (AKI), which worsens their outcomes. The metabolic and inflammatory changes associated with AKI likely contribute to prolonged brain injury and edema. As a result, recognizing its presence is important for effectively managing ABI and its sequelae. This review discusses the occurrence and effects of AKI in critically ill adults with neurological conditions, outlines potential mechanisms connecting AKI and ABI progression, and highlights AKI management principles. Tailored approaches include optimizing blood pressure, managing intracranial pressure, adjusting medication dosages, and assessing the type of administered fluids. Preventive measures include avoiding nephrotoxic drugs, improving hemodynamic and fluid balance, and addressing coexisting AKI syndromes. ABI patients undergoing renal replacement therapy (RRT) are more susceptible to neurological complications. RRT can negatively impact cerebral blood flow, intracranial pressure, and brain tissue oxygenation, with effects tied to specific RRT methods. Continuous RRT is favored for better hemodynamic stability and lower risk of dialysis disequilibrium syndrome. Potential RRT modifications for ABI patients include adjusted dialysate and blood flow rates, osmotherapy, and alternate anticoagulation methods. Future research should explore whether these strategies enhance outcomes and if using novel AKI biomarkers can mitigate AKI-related complications in ABI patients.

Keywords: Dialysis disequilibrium syndrome; Intracerebral hemorrhage; Renal replacement therapy; Stroke; Subarachnoid hemorrhage; Traumatic brain injury; Uremia.

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Conflict of interest statement

JAN reports consultancy agreements with Baxter Healthcare, Outset Medical, Vifor Pharma, and Leadiant Biosciences, all unrelated to this work. AT reports consultancy for Baxter, receiving honoraria from UptoDate, having a patent on 0.5% trisodium citrate solution for CRRT anti- coagulation, the license for which has been bought by Baxter, and serving on a speakers bureau for Baxter, all unrelated to this work. MHR has received consultant fees from Baxter Healthcare, serves as on the Data Safety Monitoring Boards of clinical trials sponsored by Reata, Travere and Astra Zeneca, all unrelated to this work. CR has received funding for lectures been consultant or advisory board member for Asahi, Astute, B. Braun, Baxter, bioMérieux, Bioporto, CytoSorbents, Estor, Fresenius Medical Care, General Electric (GE), Jafron, Medtronic, Toray. FH-S, TT, and GR-G declare no competing interests.

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