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Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II

OBJECTIVE: Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of a...

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Autores principales: Tumlin, James A., Murugan, Raghavan, Deane, Adam M., Ostermann, Marlies, Busse, Laurence W., Ham, Kealy R., Kashani, Kianoush, Szerlip, Harold M., Prowle, John R., Bihorac, Azra, Finkel, Kevin W., Zarbock, Alexander, Forni, Lui G., Lynch, Shannan J., Jensen, Jeff, Kroll, Stew, Chawla, Lakhmir S., Tidmarsh, George F., Bellomo, Rinaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959265/
https://www.ncbi.nlm.nih.gov/pubmed/29509568
http://dx.doi.org/10.1097/CCM.0000000000003092
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author Tumlin, James A.
Murugan, Raghavan
Deane, Adam M.
Ostermann, Marlies
Busse, Laurence W.
Ham, Kealy R.
Kashani, Kianoush
Szerlip, Harold M.
Prowle, John R.
Bihorac, Azra
Finkel, Kevin W.
Zarbock, Alexander
Forni, Lui G.
Lynch, Shannan J.
Jensen, Jeff
Kroll, Stew
Chawla, Lakhmir S.
Tidmarsh, George F.
Bellomo, Rinaldo
author_facet Tumlin, James A.
Murugan, Raghavan
Deane, Adam M.
Ostermann, Marlies
Busse, Laurence W.
Ham, Kealy R.
Kashani, Kianoush
Szerlip, Harold M.
Prowle, John R.
Bihorac, Azra
Finkel, Kevin W.
Zarbock, Alexander
Forni, Lui G.
Lynch, Shannan J.
Jensen, Jeff
Kroll, Stew
Chawla, Lakhmir S.
Tidmarsh, George F.
Bellomo, Rinaldo
author_sort Tumlin, James A.
collection PubMed
description OBJECTIVE: Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy. DESIGN: Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial. SETTING: ICUs. PATIENTS: Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively). INTERVENTIONS: IV angiotensin II or placebo. MEASUREMENTS AND MAIN RESULTS: Primary end point: survival through day 28; secondary outcomes included renal recovery through day 7 and increase in mean arterial pressure from baseline of ≥ 10 mm Hg or increase to ≥ 75 mm Hg at hour 3. Survival rates through day 28 were 53% (95% CI, 38%–67%) and 30% (95% CI, 19%–41%) in patients treated with angiotensin II and placebo (p = 0.012), respectively. By day 7, 38% (95% CI, 25%–54%) of angiotensin II patients discontinued RRT versus 15% (95% CI, 8%–27%) placebo (p = 0.007). Mean arterial pressure response was achieved in 53% (95% CI, 38%–68%) and 22% (95% CI, 12%–34%) of patients treated with angiotensin II and placebo (p = 0.001), respectively. CONCLUSIONS: In patients with acute kidney injury requiring renal replacement therapy at study drug initiation, 28-day survival and mean arterial pressure response were higher, and rate of renal replacement therapy liberation was greater in the angiotensin II group versus the placebo group. These findings suggest that patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy may preferentially benefit from angiotensin II.
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spelling pubmed-59592652018-06-01 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II Tumlin, James A. Murugan, Raghavan Deane, Adam M. Ostermann, Marlies Busse, Laurence W. Ham, Kealy R. Kashani, Kianoush Szerlip, Harold M. Prowle, John R. Bihorac, Azra Finkel, Kevin W. Zarbock, Alexander Forni, Lui G. Lynch, Shannan J. Jensen, Jeff Kroll, Stew Chawla, Lakhmir S. Tidmarsh, George F. Bellomo, Rinaldo Crit Care Med Clinical Investigations OBJECTIVE: Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy. DESIGN: Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial. SETTING: ICUs. PATIENTS: Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively). INTERVENTIONS: IV angiotensin II or placebo. MEASUREMENTS AND MAIN RESULTS: Primary end point: survival through day 28; secondary outcomes included renal recovery through day 7 and increase in mean arterial pressure from baseline of ≥ 10 mm Hg or increase to ≥ 75 mm Hg at hour 3. Survival rates through day 28 were 53% (95% CI, 38%–67%) and 30% (95% CI, 19%–41%) in patients treated with angiotensin II and placebo (p = 0.012), respectively. By day 7, 38% (95% CI, 25%–54%) of angiotensin II patients discontinued RRT versus 15% (95% CI, 8%–27%) placebo (p = 0.007). Mean arterial pressure response was achieved in 53% (95% CI, 38%–68%) and 22% (95% CI, 12%–34%) of patients treated with angiotensin II and placebo (p = 0.001), respectively. CONCLUSIONS: In patients with acute kidney injury requiring renal replacement therapy at study drug initiation, 28-day survival and mean arterial pressure response were higher, and rate of renal replacement therapy liberation was greater in the angiotensin II group versus the placebo group. These findings suggest that patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy may preferentially benefit from angiotensin II. Lippincott Williams & Wilkins 2018-06 2018-05-16 /pmc/articles/PMC5959265/ /pubmed/29509568 http://dx.doi.org/10.1097/CCM.0000000000003092 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Clinical Investigations
Tumlin, James A.
Murugan, Raghavan
Deane, Adam M.
Ostermann, Marlies
Busse, Laurence W.
Ham, Kealy R.
Kashani, Kianoush
Szerlip, Harold M.
Prowle, John R.
Bihorac, Azra
Finkel, Kevin W.
Zarbock, Alexander
Forni, Lui G.
Lynch, Shannan J.
Jensen, Jeff
Kroll, Stew
Chawla, Lakhmir S.
Tidmarsh, George F.
Bellomo, Rinaldo
Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
title Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
title_full Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
title_fullStr Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
title_full_unstemmed Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
title_short Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
title_sort outcomes in patients with vasodilatory shock and renal replacement therapy treated with intravenous angiotensin ii
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959265/
https://www.ncbi.nlm.nih.gov/pubmed/29509568
http://dx.doi.org/10.1097/CCM.0000000000003092
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