Zusammenfassung
Die akute Nierenschädigung (AKI) ist zusammen mit dem Lungenversagen das häufigste Organversagen in der Intensivmedizin und hat direkten Einfluss auf Morbidität und Mortalität. Damit befinden sich die Nieren mit an der Spitze der betroffenen Organsysteme kritisch Kranker. Meist handelt es sich hierbei um eine Schädigung im Rahmen der kritischen Erkrankung selbst, wie z. B. einer Sepsis, und nicht um primäre renale Erkrankungen. Mit der Schwere des AKI steigt die Mortalität der Patienten nahezu linear an [10], was einerseits die Schwere der Grunderkrankung widerspiegelt, andererseits aber auch als Ausdruck eines davon unabhängigen Einflusses eines AKI auf die Mortalität kritisch Kranker gilt [7]. Zahlreiche intensivmedizinische Konstellationen erhöhen das Risiko für das Auftreten eines AKI. Die Nierenschädigung selbst und der damit einhergehende Verlust der physiologischen Aufgaben der Nieren ist eng verzahnt mit der Funktion anderer Organsysteme und erfordert unabhängig von der etwaigen Notwendigkeit einer Nierenersatztherapie in vielerlei Hinsicht eine Berücksichtigung bei der intensivmedizinischen Therapie.
Abstract
Acute kidney injury (AKI) and acute lung injury (ALI) are the most common organ failures in intensive care medicine. AKI significantly impacts morbidity and mortality of affected patients. It often occurs in settings of critical illnesses like sepsis, rather than as a consequence of primary renal diseases. The severity of AKI correlates almost linearly with mortality. It often mirrors the critical illness of the patient but is also an independent predictor of mortality. A variety of conditions in patients under intensive care are associated with the development of AKI. Irrespective of the need for kidney replacement therapy reduction or even loss of kidney function with its wide impact on physiological functions is challenging and requires consideration and a broad adaptation of treatment on intensive care units.
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Literatur
Asfar P, Meziani F, Hamel JF et al (2014) High versus low blood-pressure target in patients with septic shock. N Engl J Med 370:1583–1593
Blanco VE, Hernandorena CV, Scibona P et al (2019) Acute kidney injury pharmacokinetic changes and Its impact on drug prescription. Healthcare 7:
Bouchard J, Soroko SB, Chertow GM et al (2009) Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 76:422–427
Brunkhorst FM, Weigand MA, Pletz M et al (2020) S3 guideline sepsis-prevention, diagnosis, therapy, and aftercare: long version. Med Klin Intensivmed Notfmed 115:37–109
Darmon M, Clec’h C, Adrie C et al (2014) Acute respiratory distress syndrome and risk of AKI among critically ill patients. Clin J Am Soc Nephrol 9:1347–1353
Finfer S, Bellomo R, Boyce N et al (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256
Fiorentino M, Tohme FA, Wang S et al (2018) Long-term survival in patients with septic acute kidney injury is strongly influenced by renal recovery. PLoS ONE 13:e198269
Ip JE, Cheung JW, Park D et al (2011) Temporal associations between thoracic volume overload and malignant ventricular arrhythmias: a study of intrathoracic impedance. J Cardiovasc Electrophysiol 22:293–299
Karagiannidis C, Bein T, Windisch W (2020) Update and comment on the German S3 “clinical guideline for treating acute respiratory insufficiency with invasive ventilation and extracorporeal membrane oxygenation: evidence-based recommendations”. Pneumologie 74:46–49
Khadzhynov D, Schmidt D, Hardt J et al (2019) The incidence of acute kidney injury and associated hospital mortality. Dtsch Arztebl Int 116:397–404
Knights KM, Rowland A, Miners JO (2013) Renal drug metabolism in humans: the potential for drug-endobiotic interactions involving cytochrome P450 (CYP) and UDP-glucuronosyltransferase (UGT). Br J Clin Pharmacol 76:587–602
Koyner JL, Davison DL, Brasha-Mitchell E et al (2015) Furosemide stress test and biomarkers for the prediction of AKI severity. J Am Soc Nephrol 26:2023–2031
Kuiper JW, Groeneveld AB, Slutsky AS et al (2005) Mechanical ventilation and acute renal failure. Crit Care Med 33:1408–1415
Lamontagne F, Richards-Belle A, Thomas K et al (2020) Effect of reduced exposure to vasopressors on 90-day mortality in older critically Ill patients with vasodilatory hypotension: a randomized clinical trial. JAMA 323:938–949
Lombardi R, Nin N, Penuelas O et al (2017) Acute kidney injury in mechanically ventilated patients: the risk factor profile depends on the timing of aki onset. Shock 48:411–417
Malbrain M, Langer T, Annane D et al (2020) Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Ann Intensive Care 10:64
Mehta RL, Bouchard J (2011) Controversies in acute kidney injury: effects of fluid overload on outcome. Contrib Nephrol 174:200–211
Messmer AS, Zingg C, Muller M et al (2020) Fluid overload and mortality in adult critical care patients—a systematic review and meta-analysis of observational studies. Crit Care Med 48:1862–1870
Morales Castro D, Dresser L, Granton J et al (2023) Pharmacokinetic alterations associated with critical illness. Clin Pharmacokinet 62:209–220
Ostermann M, Hall A, Crichton S (2017) Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients—a retrospective analysis. BMC Nephrol 18:151
Payen D, De Pont AC, Sakr Y et al (2008) A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 12:R74
Raimundo M, Crichton S, Syed Y et al (2015) Low systemic oxygen delivery and BP and risk of progression of early AKI. Clin J Am Soc Nephrol 10:1340–1349
Schortgen F, Lacherade JC, Bruneel F et al (2001) Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 357:911–916
Semler MW, Self WH, Wanderer JP et al (2018) Balanced crystalloids versus saline in critically ill adults. N Engl J Med 378:829–839
Van Den Akker JP, Egal M, Groeneveld AB (2013) Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care 17:R98
Van Regenmortel N, Verbrugghe W, Roelant E et al (2018) Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population. Intensive Care Med 44:409–417
Villa G, Husain-Syed F, Saitta T et al (2021) Hemodynamic instability during acute kidney injury and acute renal replacement therapy: pathophysiology and clinical implications. Blood Purif 50:729–739
Vivino G, Antonelli M, Moro ML et al (1998) Risk factors for acute renal failure in trauma patients. Intensive Care Med 24:808–814
Wong BT, Chan MJ, Glassford NJ et al (2015) Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury. J Crit Care 30:975–981
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S. Grampp und C. Willam geben an, dass kein Interessenkonflikt besteht.
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Kai-Uwe Eckardt, Berlin
Kirsten de Groot, Offenbach am Main
Kai Schmidt-Ott, Hannover
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Grampp, S., Willam, C. Therapeutische Relevanz – Einfluss eines AKI auf die intensivmedizinische Therapie. Nephrologie (2024). https://doi.org/10.1007/s11560-024-00726-1
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DOI: https://doi.org/10.1007/s11560-024-00726-1