Cargando…

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

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 i...

Descripción completa

Detalles Bibliográficos
Autores principales: Mariano, Filippo, De Biase, Consuelo, Hollo, Zsuzsanna, Deambrosis, Ilaria, Davit, Annalisa, Mella, Alberto, Bergamo, Daniela, Maffei, Stefano, Rumbolo, Francesca, Papaleo, Alberto, Stella, Maurizio, Biancone, Luigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703301/
https://www.ncbi.nlm.nih.gov/pubmed/34945056
http://dx.doi.org/10.3390/jcm10245760
_version_ 1784621430607970304
author Mariano, Filippo
De Biase, Consuelo
Hollo, Zsuzsanna
Deambrosis, Ilaria
Davit, Annalisa
Mella, Alberto
Bergamo, Daniela
Maffei, Stefano
Rumbolo, Francesca
Papaleo, Alberto
Stella, Maurizio
Biancone, Luigi
author_facet Mariano, Filippo
De Biase, Consuelo
Hollo, Zsuzsanna
Deambrosis, Ilaria
Davit, Annalisa
Mella, Alberto
Bergamo, Daniela
Maffei, Stefano
Rumbolo, Francesca
Papaleo, Alberto
Stella, Maurizio
Biancone, Luigi
author_sort Mariano, Filippo
collection PubMed
description 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.
format Online
Article
Text
id pubmed-8703301
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-87033012021-12-25 Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury Mariano, Filippo De Biase, Consuelo Hollo, Zsuzsanna Deambrosis, Ilaria Davit, Annalisa Mella, Alberto Bergamo, Daniela Maffei, Stefano Rumbolo, Francesca Papaleo, Alberto Stella, Maurizio Biancone, Luigi J Clin Med Article 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. MDPI 2021-12-09 /pmc/articles/PMC8703301/ /pubmed/34945056 http://dx.doi.org/10.3390/jcm10245760 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mariano, Filippo
De Biase, Consuelo
Hollo, Zsuzsanna
Deambrosis, Ilaria
Davit, Annalisa
Mella, Alberto
Bergamo, Daniela
Maffei, Stefano
Rumbolo, Francesca
Papaleo, Alberto
Stella, Maurizio
Biancone, Luigi
Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury
title Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury
title_full Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury
title_fullStr Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury
title_full_unstemmed Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury
title_short Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury
title_sort long-term preservation of renal function in septic shock burn patients requiring renal replacement therapy for acute kidney injury
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703301/
https://www.ncbi.nlm.nih.gov/pubmed/34945056
http://dx.doi.org/10.3390/jcm10245760
work_keys_str_mv AT marianofilippo longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT debiaseconsuelo longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT hollozsuzsanna longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT deambrosisilaria longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT davitannalisa longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT mellaalberto longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT bergamodaniela longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT maffeistefano longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT rumbolofrancesca longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT papaleoalberto longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT stellamaurizio longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury
AT bianconeluigi longtermpreservationofrenalfunctioninsepticshockburnpatientsrequiringrenalreplacementtherapyforacutekidneyinjury