Sepsis is a common cause of acute renal failure in intensive care units (ICU) with mortality rates as high as 60%. In this study, the clinical and laboratory predictors of acute kidney injury (AKI) in critically ill Turkish patients with sepsis/systemic inflammatory response syndrome were identified. We studied 139 (67 females/72 males) patients admitted to our ICUs with sepsis/systemic inflammatory response syndrome without renal failure. The clinical and laboratory parameters and treatments were recorded. Patients were classified as those without AKI (n = 60; 43.20%) and those with AKI (n = 79; 56.80%) based on the RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria. Those with AKI were further classified as: risk in 27 (19%), injury in 25 (17.9%), failure in 25 (17.9%), and loss in 2 (1.4%). We found that the mortality rate increased with the severity of renal involvement: 56% in risk, 68% in injury, 72% in failure, and 100% in loss categories. Patients with AKI had a more positive fluid balance, higher central venous pressure, more vasopressor use, and lower systolic blood pressure. In multivariate analysis, the sequential organ failure assessment score, blood pressure, serum creatinine, and fluid balance were risk factors for the development of AKI. In this population, the incidence of AKI was higher and contrary to previous knowledge. A positive fluid balance also carries a risk for AKI and mortality in septic ICU patients. The RIFLE criteria were found to be applicable to our ICU population.

Keywords:
Acute renal failure, RIFLE criteria, Sepsis/systemic inflammatory response syndrome
1.
Kellum JA: Acute kidney injury. Crit Care Med 2008;36(4 suppl):S141–S145.
2.
Lameire N, Van Biesen W, Vanholder R: Acute renal failure. Lancet 2005;365:417–430.
3.
Schrier RW, Wang W: Acute renal failure and sepsis. N Engl J Med 2004;351:159–169.
4.
Rangel-Frausto MS, Pitted D, Costigan M: The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. JAMA 1995;273:117–123.
5.
Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ: Acute renal failure in intensive care units: causes, outcome, and prognostic factors of hospital mortality: a prospective, multicenter study. Crit Care Med 1996;24:192–198.
6.
Liano F, Junco E, Pascual J, Madero R, Verde E: The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. Kidney Int Suppl 1998;66:S16–S24.
7.
Wan L, Bagshaw SM, Langenberg C, Saotome T, May C, Bellomo R: Pathophysiology of septic acute kidney injury: what do we really know? Crit Care Med 2008;36(4 suppl): S198–S203.
8.
Wan L, Bellomo R, Di Giantomasso D, Ronco C: The pathogenesis of septic acute renal failure. Curr Opin Crit Care 2003;9:496–502.
9.
Bellomo R, Wan L, Langenberg C, May C: Septic acute kidney injury: new concepts. Nephron Exp Nephrol 2008;109:e95–e100.
10.
Yegenaga I, Hoste E, Van Biesen W, Vanholder R, Benoit D, Kantarci G, Dhondt A, Colardyn F, Lameire N: Clinical characteristics of patients developing acute renal failure due to sepsis/SIRS: results of prospective study. Am J Kidney Dis 2004;43:817–824.
11.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–874.
12.
Bone RC: Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 1996;125:680–687.
13.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevski P, Acute Dialysis Quality Initiative Workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:204–212.
14.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
15.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
16.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.
17.
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of SOFA Score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis related problems’ of the European Society of Intensive Care Medicine. Crit Care Med 1998;26:1793–1800.
18.
Ostermann M, Chang RW: Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007;35:1837–1843.
19.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Acute renal failure in critically ill patients: a multicenter study. JAMA 2005;295:813–818.
20.
Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C, North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI) Investigators: Targeting the problem with the RIFLE criteria. Clin J Am Soc Nephrol 2007;2:418–425.
21.
Mehta RL, Pascual MT, Soroko S, Chertow GM (PICARD Study Group): Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288:2547–2553.
22.
Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Nacedo E, Gibney N, Tolwani A, Ronco C, Kellum JA, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Diuretics and mortality in acute renal failure. Crit Care Med 2004;32:1669–1677.
23.
Davis A, Gooch I: The use of loop diuretics in acute renal failure in critically ill patients to reduce mortality, maintain renal function or to avoid the requirement for renal support. Emerg Med J 2006;23:569–570.
24.
Bagshow SM, George C, Bellomo R, ANZICS Database Management Committee: Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care 2008;12:R47.
25.
Bangshow SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudeman-van Straaten HM, Ronco C, Kellum JA, Beginning and Ending Supportive Therapy for Kidney (BEST Kidney) Investigators: Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2:431–439.
26.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D, Sepsis Occurrence in Acutely Ill Patients Investigators: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34:344–353.
27.
Kellum JA, Levin N, Bouman C, Lameire N: Developing a consensus classification system for acute renal failure. Curr Opin Crit Care 2002;8:509–514.
28.
Kellum JA, Ronco C, Mehta R, Bellomo R: Consensus development in acute renal failure: the Acute Dialysis Quality Initiative. Curr Opin Crit Care 2005;11:527–532.
29.
Van Biesen W, Vanholder R, Lameire N: Defining acute renal failure: RIFLE and beyond. Clin J Am Soc Nephrol 2006;1:1314–1319.
30.
Schrier RW, Wang W: Acute renal failure and sepsis. N Engl J Med 2004;51:2;159–169.
31.
Van Biesen W, Yegenaga I, Vanholder R, Verbeke F, Hoste E, Colardyn F, Lameire N: Relationship between fluid status and its management on acute renal failure in intensive care unit (ICU) patients with sepsis: a prospective analysis. J Nephrol 2005;18:54–60.
32.
Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL, Sepsis Occurrence in Acutly Ill Patients (SOAP) Investigators: A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008;12:R74.
33.
Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA: Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest 2000;117:1749–1754.
34.
Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N: Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 2008;34:707–713.
35.
Malbraina ML, Deeren D, De Potter TJ: Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005;11:156–171.
36.
Esson ML, Schrier RW: Diagnosis and treatment of acute tubular necrosis. Ann Intern Med 2002;137:744–752.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.