AIM: Cardiac arrest (CA) in humans causes warm renal ischemia-reperfusion injury, similar to animal models of ischemic acute kidney injury (AKI). We aimed to investigate the incidence and risk associations of AKI after CA, with or without post-resuscitation cardiogenic shock (PRCS). METHODS: We examined the renal outcomes of adult patients admitted to the intensive care unit (ICU), who survived for more than 48 h following successful resuscitation after CA. RESULTS: Of 105 patients (median age 65 years; 69% male), 58 (55.2%) had PRCS and were on vasoactive drugs beyond 24h; and 9 (8.6%) (all of whom had PRCS) received renal replacement therapy. Only 3 (6.4%) of 47 patients without PRCS had RIFLE-'I'/'F' AKI, compared to 30 (51.7%) of 58 patients with PRCS (p<0.001). Median peak serum creatinine in the non-PRCS group was 102 μmol/L (interquartile range 85-115), compared to 155 μmol/L (interquartile range 112-267) (p<0.001) in the PRCS group. On multivariate analysis, cumulative noradrenaline dose during the first 24h in ICU, PRCS, and pre-CA renin-angiotensin-aldosterone-system blockade were independently associated with RIFLE-'I'/'F' AKI; while higher serum lactate 12h after CA, baseline creatinine, and PRCS were independently associated with greater rise in creatinine from pre-CA levels. Estimated time without spontaneous circulation, total adrenaline dose and initial cardiac rhythm during CA, had no independent associations with renal outcomes. CONCLUSIONS: In the absence of PRCS, CA in isolation is uncommonly associated with significant AKI. The human kidney may be more resistant to warm ischemia-reperfusion injury than previously thought.
AIM: Cardiac arrest (CA) in humans causes warm renal ischemia-reperfusion injury, similar to animal models of ischemic acute kidney injury (AKI). We aimed to investigate the incidence and risk associations of AKI after CA, with or without post-resuscitation cardiogenic shock (PRCS). METHODS: We examined the renal outcomes of adult patients admitted to the intensive care unit (ICU), who survived for more than 48 h following successful resuscitation after CA. RESULTS: Of 105 patients (median age 65 years; 69% male), 58 (55.2%) had PRCS and were on vasoactive drugs beyond 24h; and 9 (8.6%) (all of whom had PRCS) received renal replacement therapy. Only 3 (6.4%) of 47 patients without PRCS had RIFLE-'I'/'F' AKI, compared to 30 (51.7%) of 58 patients with PRCS (p<0.001). Median peak serum creatinine in the non-PRCS group was 102 μmol/L (interquartile range 85-115), compared to 155 μmol/L (interquartile range 112-267) (p<0.001) in the PRCS group. On multivariate analysis, cumulative noradrenaline dose during the first 24h in ICU, PRCS, and pre-CA renin-angiotensin-aldosterone-system blockade were independently associated with RIFLE-'I'/'F' AKI; while higher serum lactate 12h after CA, baseline creatinine, and PRCS were independently associated with greater rise in creatinine from pre-CA levels. Estimated time without spontaneous circulation, total adrenaline dose and initial cardiac rhythm during CA, had no independent associations with renal outcomes. CONCLUSIONS: In the absence of PRCS, CA in isolation is uncommonly associated with significant AKI. The human kidney may be more resistant to warm ischemia-reperfusion injury than previously thought.
Authors: Hernando Gomez; Can Ince; Daniel De Backer; Peter Pickkers; Didier Payen; John Hotchkiss; John A Kellum Journal: Shock Date: 2014-01 Impact factor: 3.454
Authors: Valentine Léopold; Etienne Gayat; Romain Pirracchio; Jindrich Spinar; Jiri Parenica; Tuukka Tarvasmäki; Johan Lassus; Veli-Pekka Harjola; Sébastien Champion; Faiez Zannad; Serafina Valente; Philip Urban; Horng-Ruey Chua; Rinaldo Bellomo; Batric Popovic; Dagmar M Ouweneel; José P S Henriques; Gregor Simonis; Bruno Lévy; Antoine Kimmoun; Philippe Gaudard; Mir Babar Basir; Andrej Markota; Christoph Adler; Hannes Reuter; Alexandre Mebazaa; Tahar Chouihed Journal: Intensive Care Med Date: 2018-06-01 Impact factor: 17.440
Authors: Sadudee Peerapornratana; Carlos L Manrique-Caballero; Hernando Gómez; John A Kellum Journal: Kidney Int Date: 2019-06-07 Impact factor: 10.612
Authors: Carlos L Manrique-Caballero; John A Kellum; Hernando Gómez; Francesca De Franco; Nicola Giacchè; Roberto Pellicciari Journal: Antioxid Redox Signal Date: 2021-03-17 Impact factor: 8.401