Risk indicators for acute kidney injury in cardiogenic shock


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Abstract

Purpose:In critical illness, the relation between the macrocirculation, microcirculation and organ dysfunction, such as acute kidney injury (AKI), is complex. This study aimed at identifying predictors for AKI in patients with cardiogenic shock.Materials and methods:Thirty-nine adult cardiogenic shock patients, with an admission creatinine <200μmoll−1, and whose microcirculation was measured within 48h were enrolled. Patient data were analyzed if AKI stage ≥1 developed according to the Kidney Disease/Improving Outcomes classification within 48h after admission. Variables with a p<.05 in the univariate analysis were considered for analysis with logistic regression.Results:Twenty-four patients (61.5%) developed AKI within 48h. The group that developed AKI had higher central venous pressures (CVP), lower diastolic arterial blood pressures and mean perfusion pressures, higher maximum ventilator pressures as well as positive end expiratory pressures and were treated with higher dosages of dobutamine. There was no difference of the microcirculation. In the multivariate logistic regression analysis, CVP was the only independent predictor for AKI (OR 1.241; 95% CI 1.030–1.495; p=.023).Conclusions:In this population of patients with cardiogenic shock, CVP was associated with the development of AKI.HIGHLIGHTSThe relation between the macrocirculation, microcirculation and organ dysfunction, such as AKI, is complex.In this study central venous pressure was independently associated with the development of AKI.Other variables, including the microcirculation and mechanical ventilation variables, were not associated with AKI.

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