Issues of acute kidney injury staging and management in sepsis and critical illness

• Verfasst von: Nußhag, Christian [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Morath, Christian [VerfasserIn]
• Verfasst von: Brenner, Thorsten [VerfasserIn]
• Titel: Issues of acute kidney injury staging and management in sepsis and critical illness
• Titelzusatz: a narrative review
• Verf.angabe: Christian Nusshag, Markus A. Weigand, Martin Zeier, Christian Morath and Thorsten Brenner
• E-Jahr: 2017
• Jahr: 28 June 2017
• Umfang: 25 S.
• Fussnoten: Gesehen am 06.10.2017
• Titel Quelle: Enthalten in: International journal of molecular sciences
• Ort Quelle: Basel : Molecular Diversity Preservation International, 2000
• Jahr Quelle: 2017
• Band/Heft Quelle: 18(2017,7) Artikel-Nummer 1387, 25 Seiten
• ISSN Quelle: 1422-0067
• ISSN Quelle: 1661-6596
• DOI: doi:10.3390/ijms18071387
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acute kidney injury
• Sach-SW: biomarkers
• Sach-SW: disease staging
• Sach-SW: glomerular filtration rate
• Sach-SW: renal replacement therapy
• Sach-SW: timing
• K10plus-PPN: 1564158888
• K10plus-PPN:
  Universitätsbibliothek
• Lokale URL UB: Zum Volltext

Abstract

Acute kidney injury (AKI) has a high incidence on intensive care units around the world and is a major complication in critically ill patients suffering from sepsis or septic shock. The short- and long-term complications are thereby devastating and impair the quality of life. Especially in terms of AKI staging, the determination of kidney function and the timing of dialytic AKI management outside of life-threatening indications are ongoing matters of debate. Despite several studies, a major problem remains in distinguishing between beneficial and unnecessary “early” or even harmful renal replacement therapy (RRT). The latter might prolong disease course and renal recovery. AKI scores, however, provide an insufficient outcome-predicting ability and the related estimation of kidney function via serum creatinine or blood urea nitrogen (BUN)/urea is not reliable in AKI and critical illness. Kidney independent alterations of creatinine- and BUN/urea-levels further complicate the situation. This review critically assesses the current AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs.