Use of vasopressors in patients with acute kidney injury on continuous kidney replacement therapy.

Autor: Ramesh A; Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America., Doddi A; Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America., Abbasi A; Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America., Al-Mamun MA; Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia, United States of America., Sakhuja A; Division of Data-Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America., Shawwa K; Division of Nephrology, Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Dec 19; Vol. 19 (12), pp. e0315643. Date of Electronic Publication: 2024 Dec 19 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0315643
Abstrakt: Objective: To investigate whether the use of a specific vasopressor was associated with increased mortality or adverse outcomes in patients with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT).
Methods: Patients with AKI who underwent CKRT between 1/1/2012-1/1/2021 at a tertiary academic hospital were included. Cox proportional hazard model was used to assess the relationship between time-dependent vasopressor dose and in-hospital mortality.
Results: There were 641 patients with AKI that required CKRT. In-hospital mortality occurred in 318 (49.6%) patients. Those who died were older (63 vs 57 years), had higher SOFA score (10.6 vs 9) and lactate (6 vs 3.3 mmol/L). In multivariable model, increasing doses of norepinephrine [HR 4.4 (95% CI: 2.3-7, p<0.001)] per 0.02 mcg/min/kg and vasopressin [HR 2.6 (95% CI: 1.9-3.2, p = 0.01)] per 0.02 unit/min during CKRT were associated with in-hospital mortality. The model was adjusted for vasopressor doses and fluid balance, SOFA score, lactate and other markers of severity of illness. Baseline vasopressor doses were not associated with mortality. Most vasopressors were associated with positive daily fluid balance. Among survivors at day 30, mean values of vasopressors were not associated with persistent kidney dysfunction.
Conclusion: The associations between norepinephrine and vasopressin with in-hospital mortality could be related to their common use in this cohort.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Ramesh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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