Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury.

Filippo Mariano,Consuelo De Biase,Ilaria Deambrosis,Stefano Maffei,Alberto Papaleo,Luigi Biancone,Zsuzsanna Hollo,Alberto Mella,Maurizio Stella,Francesca Rumbolo,Annalisa Davit,Daniela Bergamo

doi:10.3390/jcm10245760

Abstract

Background. The real impact of septic shock-associated acute kidney injury (AKI) on the long-term renal outcome is still debated, and little is known about AKI-burn patients. In a cohort of burn survivors treated by continuous renal replacement therapy (CRRT) and sorbent technology (CPFA-CRRT), we investigated the long-term outcome of glomerular and tubular function. Methods. Out of 211 burn patients undergoing CRRT from 2001 to 2017, 45 survived, 40 completed the clinical follow-up (cumulative observation period 4067 months, median 84 months, IR 44-173), and 30 were alive on 31 December 2020. Besides creatinine and urine albumin, in the 19 patients treated with CPFA-CRRT, we determined the normalized GFR by 99mTc-DTPA (NRI-GFR) and studied glomerular and tubular urine protein markers. Results. At the follow-up endpoint, the median plasma creatinine and urine albumin were 0.99 (0.72–1.19) and 0.0 mg/dL (0.0–0.0), respectively. NRI-GFR was 103.0 mL/min (93.4–115). Four patients were diabetic, and 22/30 presented at least one risk factor for chronic disease (hypertension, dyslipidemia, and overweight). Proteinuria decreased over time, from 0.47 g/day (0.42–0.52) at 6 months to 0.134 g/day (0.09–0.17) at follow-up endpoint. Proteinuria positively correlated with the peak of plasma creatinine (r 0.6953, p 0.006) and the number of CRRT days (r 0.5650, p 0.035) during AKI course, and negatively with NRI–GFR (r −0.5545, p 0.049). In seven patients, urine protein profile showed a significant increase of glomerular marker albumin and glomerular/tubular index. Conclusions. Burn patients who experienced septic shock and AKI treated with CRRT had a long-term expectation of preserved renal function. However, these patients were more predisposed to microalbuminuria, diabetes, and the presence of risk factors for intercurrent comorbidities and chronic renal disease.

Highlights

Acute kidney injury (AKI) sustained by septic shock is a severe complication in critically ill patients, influencing patient survival and kidney functions in the long term.Observational studies demonstrated a significant risk of deterioration of renal function in patients that survived an episode of acute kidney injury (AKI), even if a “renal recovery”, as determined by the return of eGFR to pre-morbid levels, occurred
Our study aims to investigate the long-term renal outcome of 30 severe burn survivors who experienced septic shock, multi-organ failure, and AKI treated with continuous renal replacement therapy (CRRT) by determining glomerular filtration rate and studying glomerular and tubular marker proteins
Baux index was similar for CRRT and CPFA-CRRT patients at the time of AKI, while age was significantly higher and TBSA lower for CRRT patients than for CPFA-CRRT patients

Summary

Introduction

Observational studies demonstrated a significant risk of deterioration of renal function in patients that survived an episode of AKI, even if a “renal recovery”, as determined by the return of eGFR to pre-morbid levels, occurred. In patients without pre-existing renal dysfunction, aging, co-morbidities, and renal function at discharge were the main determinants of the long-term functional outcome [1,2]. These observations led to a discussion on the causal relationship between AKI and CKD, and on the role of preexisting comorbidities such as diabetes, hypertension, cardiovascular disease, and preexisting CKD [1–4]. Characterizing and identifying selected individuals with the highest risk for chronic renal disease is of great importance [2–4]

Methods

Results

Conclusion