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

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

doi:10.1186/cc13133

Abstract

IntroductionThe 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.MethodsA 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).ResultsThis 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.ConclusionsWe 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.

Highlights

The role of systemic hemodynamics in the pathogenesis of septic acute kidney injury (AKI) has received little attention
In this study, we observed a loose association between most systemic hemodynamic parameters and development of new or persistent AKI in septic patients, with the exception of central venous pressure (CVP)
The association of the level of CVP and the risk of developing AKI suggests a role of venous congestion in the development of AKI

Summary

Introduction

The role of systemic hemodynamics in the pathogenesis of septic acute kidney injury (AKI) has received little attention. Sepsis is the leading cause of acute kidney injury (AKI) in critically ill patients [1] and is associated with high inhospital mortality, exceeding 50% when AKI is part of a multiple organ failure syndrome. Among the factors predisposing patients to AKI, two seem to predominate: (1) macro- and microhemodynamic impairment [2] and (2) immune toxicity in kidney tissue cells [3]. It has been suggested for a long time, the role of compromised

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