Advertisement

Acute Kidney Injury and Delirium: Kidney–Brain Crosstalk

  • R. Y. Y. Wan
  • M. OstermannEmail author
Chapter
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Abstract

Delirium is widely recognized as a form of fluctuating dysfunction of the brain and occurs in up to 70% of the critically ill [1]. It is associated with increased morbidity, longer hospital stay, cognitive decline with associated loss of quality of life, and death [1–4]. Recognition of delirium remains a challenge. Completion of delirium screening involves first using a validated sedation scale to assess eligibility for cognitive assessment, followed by a validated delirium screening tool. This may not be possible to complete if patients are in a coma, unable to understand the language or have established cognitive dysfunction (e.g., dementia, mental disorders) [5, 7]. Furthermore, delirium assessments will only reflect the cognitive state of the patient at the time of the assessment, making it difficult to capture this fluctuating cognitive disorder. As a result, the prevalence of delirium is likely to be underestimated. Furthermore, with no proven effective pharmacological therapy, delirium in the critically ill continues to pose a healthcare burden and a management conundrum for clinicians [8–10].

References

  1. 1.
    Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005;11:360–8.PubMedGoogle Scholar
  2. 2.
    Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753–62.CrossRefGoogle Scholar
  3. 3.
    Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180:1092–7.CrossRefGoogle Scholar
  4. 4.
    Svenningsen H, Tonnesen EK, Videbech P, Frydenberg M, Christensen D, Egerod I. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study. J Clin Nurs. 2014;23:634–44.CrossRefGoogle Scholar
  5. 5.
    Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703–10.CrossRefGoogle Scholar
  6. 6.
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–64.CrossRefGoogle Scholar
  7. 7.
    Reade MC, Eastwood GM, Peck L, Bellomo R, Baldwin I. Routine use of the confusion assessment method for the intensive care unit (CAM-ICU) by bedside nurses may underdiagnose delirium. Crit Care Resusc. 2011;13:217–24.PubMedGoogle Scholar
  8. 8.
    Jubran A, Lawm G, Kelly J, et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med. 2010;36:828–35.CrossRefGoogle Scholar
  9. 9.
    Al-Qadheeb NS, Balk EM, Fraser GL, et al. Randomized ICU trials do not demonstrate an association between interventions that reduce delirium duration and short-term mortality: a systematic review and meta-analysis. Crit Care Med. 2014;42:1442–54.CrossRefGoogle Scholar
  10. 10.
    Sharma A, Malhotra S, Grover S, Jindal SK. Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: a study from India. Gen Hosp Psychiatry. 2012;34:639–46.CrossRefGoogle Scholar
  11. 11.
    Williams ST. Pathophysiology of encephalopathy and delirium. J Clin Neurophysiol. 2013;30:435–7.CrossRefGoogle Scholar
  12. 12.
    Abraham CM, Obremskey WT, Song Y, Jackson JC, Ely EW, Archer KR. Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage. Arch Phys Med Rehabil. 2014;95:2382–9.CrossRefGoogle Scholar
  13. 13.
    Wassenaar A, Schoonhoven L, Devlin JW, et al. Delirium prediction in the intensive care unit: comparison of two delirium prediction models. Crit Care. 2018;22:114.CrossRefGoogle Scholar
  14. 14.
    van den Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.CrossRefGoogle Scholar
  15. 15.
    Abraha I, Trotta F, Rimland JM, et al. Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP Series. PLoS One. 2015;10:e0123090.CrossRefGoogle Scholar
  16. 16.
    Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.CrossRefGoogle Scholar
  17. 17.
    Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006;54:479–84.CrossRefGoogle Scholar
  18. 18.
    Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L. A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients. Crit Care. 2008;12:R16.CrossRefGoogle Scholar
  19. 19.
    Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: executive summary. Am J Health Syst Pharm. 2013;70:53–8.CrossRefGoogle Scholar
  20. 20.
    Arumugam S, El-Menyar A, Al-Hassani A, et al. Delirium in the intensive care unit. J Emerg Trauma Shock. 2017;10:37–46.Google Scholar
  21. 21.
    Neto AS, Nassar AP Jr, Cardoso SO, et al. Delirium screening in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2012;40:1946–51.CrossRefGoogle Scholar
  22. 22.
    Gusmao-Flores D, Salluh JI, Chalhub RA, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16:R115.CrossRefGoogle Scholar
  23. 23.
    Devlin JW, Marquis F, Riker RR, et al. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Crit Care. 2008;12:R19.CrossRefGoogle Scholar
  24. 24.
    Pandharipande PP, Ely EW, Arora RC, et al. The intensive care delirium research agenda: a multinational, interprofessional perspective. Intensive Care Med. 2017;43:1329–39.CrossRefGoogle Scholar
  25. 25.
    Pisani MA, Murphy TE, Van Ness PH, Araujo KL, Inouye SK. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med. 2007;167:1629–34.CrossRefGoogle Scholar
  26. 26.
    Pandharipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104:21–6.CrossRefGoogle Scholar
  27. 27.
    Serafim RB, Dutra MF, Saddy F, et al. Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes. Ann Intensive Care. 2012;2:1–6.CrossRefGoogle Scholar
  28. 28.
    Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009;13:R77.CrossRefGoogle Scholar
  29. 29.
    Volpe BT, Berlin RA, Frankfurt M. The brain at risk: the sepsis syndrome and lessons from preclinical experiments. Immunol Res. 2015;63:70–4.CrossRefGoogle Scholar
  30. 30.
    Anderson ST, Commins S, Moynagh PN, Coogan AN. Lipopolysaccharide-induced sepsis induces long-lasting affective changes in the mouse. Brain Behav Immun. 2015;43:98–109.CrossRefGoogle Scholar
  31. 31.
    Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013;21:1190–222.CrossRefGoogle Scholar
  32. 32.
    van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet. 2010;375:773–5.CrossRefGoogle Scholar
  33. 33.
    Lu R, Kiernan MC, Murray A, Rosner MH, Ronco C. Kidney–brain crosstalk in the acute and chronic setting. Nat Rev Nephrol. 2015;11:707–19.CrossRefGoogle Scholar
  34. 34.
    Van Sandwijk MS, Ten Berge IJ, Majoie CB, et al. Cognitive changes in chronic kidney disease and after transplantation. Transplantation. 2016;100:734–42.CrossRefGoogle Scholar
  35. 35.
    Griva K, Thompson D, Jayasena D, Davenport A, Harrison M, Newman SP. Cognitive functioning pre- to post-kidney transplantation – a prospective study. Nephrol Dial Transplant. 2006;21:3275–82.CrossRefGoogle Scholar
  36. 36.
    Siew ED, Fissell WH, Tripp CM, et al. Acute kidney injury as a risk factor for delirium and coma during critical illness. Am J Respir Crit Care Med. 2016;195(12):1597–607.CrossRefGoogle Scholar
  37. 37.
    Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411–23.CrossRefGoogle Scholar
  38. 38.
    Piccinni P, Cruz DN, Gramaticopolo S, et al. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol. 2011;77:1072–83.PubMedGoogle Scholar
  39. 39.
    Ostermann M. Diagnosis of acute kidney injury: Kidney Disease Improving Global Outcomes criteria and beyond. Curr Opin Crit Care. 2014;20:581–7.CrossRefGoogle Scholar
  40. 40.
    Ostermann M, Joannidis M. Acute kidney injury in 2016: diagnosis and diagnostic workup. Crit Care. 2016;20:299.CrossRefGoogle Scholar
  41. 41.
    de Mendonca A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21.CrossRefGoogle Scholar
  42. 42.
    Okusa MD, Davenport A. Reading between the (guide)lines--the KDIGO practice guideline on acute kidney injury in the individual patient. Kidney Int. 2014;85:39–48.CrossRefGoogle Scholar
  43. 43.
    Rewa O, Bagshaw SM. Acute kidney injury-epidemiology, outcomes and economics. Nat Rev Nephrol. 2014;10:193–207.CrossRefGoogle Scholar
  44. 44.
    Grams ME, Rabb H. The distant organ effects of acute kidney injury. Kidney Int. 2012;81:942–8.CrossRefGoogle Scholar
  45. 45.
    Akcay A, Nguyen Q, Edelstein CL. Mediators of inflammation in acute kidney injury. Mediat Inflamm. 2009;2009:137072.CrossRefGoogle Scholar
  46. 46.
    Yap SC, Lee HT. Acute kidney injury and extrarenal organ dysfunction: new concepts and experimental evidence. Anesthesiology. 2012;116:1139–48.CrossRefGoogle Scholar
  47. 47.
    Ostermann M, Chawla LS, Forni LG, et al. Drug management in acute kidney disease – report of the ADQI XVI meeting. Br J Clin Pharmacol. 2018;84:396–403.CrossRefGoogle Scholar
  48. 48.
    Shaw AR, Chaijamorn W, Mueller BA. We underdose antibiotics in patients on CRRT. Semin Dial. 2016;29:278–80.CrossRefGoogle Scholar
  49. 49.
    Eyler RF, Mueller BA. Antibiotic dosing in critically ill patients with acute kidney injury. Nat Rev Nephrol. 2011;7:226–35.CrossRefGoogle Scholar
  50. 50.
    Guerra C, Linde-Zwirble WT, Wunsch H. Risk factors for dementia after critical illness in elderly Medicare beneficiaries. Crit Care. 2012;16:R233.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PharmacyGuy’s & St Thomas’ NHS Foundation TrustLondonUK
  2. 2.Departments of Critical Care and NephrologyKing’s College London, Guy’s & St Thomas’ NHS Foundation TrustLondonUK

Personalised recommendations