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Renal Replacement Therapy During Septic Renal Dysfunction

  • S. Romagnoli
  • Z. Ricci
  • C. RoncoEmail author
Chapter
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Abstract

Sepsis-induced acute kidney injury (AKI) represents the leading cause of AKI in the intensive care unit (ICU). This syndrome is characterized by an acute deterioration of renal function and glomerular filtration in the context of sepsis and multiple organ damage. Sepsis-induced AKI is diagnosed in almost 50% of critically ill septic patients and 15–20% of them require renal replacement therapy (RRT) [1]. Moreover the syndrome is associated with short and long-term adverse outcomes including mortality and the development of chronic kidney disease [2]. Hemodynamic support and avoidance of toxic drugs (contrast media, non-steroidal anti-inflammatory drugs, antibiotics) still remain the most efficient strategies aimed at preventing or treating sepsis-induced AKI together with the administration of diuretics to balance fluid administration and the application of RRT in oligoanuric patients and/or those with severe acid base and electrolyte derangements [3]. Fifty to 60% of patients with sepsis-induced AKI receiving RRT in the ICU do not survive the hospital admission as also remarked in the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study in which patients with sepsis-induced AKI receiving continuous RRT (CRRT) had a longer hospital length of stay and higher mortality (70%) compared with those who received RRT outside the septic syndrome (52%) [4].

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Intensive CareAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  2. 2.Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care UnitBambino Gesù Children’s Hospital, IRCCSRomeItaly
  3. 3.Department of Nephrology, Dialysis and TransplantationSan Bortolo HospitalVicenzaItaly
  4. 4.International Renal Research Institute of Vicenza (IRRIV)VicenzaItaly

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