Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
Year: 2018
Type: article
Abstract: OBJECTIVE: Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy. DESIGN: Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial. SETTING: ICUs. PATIENTS: Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively). INTERVENTIONS: IV angiotensin II or placebo. MEASUREMENTS AND MAIN RESULTS: Primary end point: survival through day 28; secondary outcomes included renal recovery through day 7 and increase in mean arterial pressure from baseline of ≥ 10 mm Hg or increase to ≥ 75 mm Hg at hour 3. Survival rates through day 28 were 53% (95% CI, 38%-67%) and 30% (95% CI, 19%-41%) in patients treated with angiotensin II and placebo (p = 0.012), respectively. By day 7, 38% (95% CI, 25%-54%) of angiotensin II patients discontinued RRT versus 15% (95% CI, 8%-27%) placebo (p = 0.007). Mean arterial pressure response was achieved in 53% (95% CI, 38%-68%) and 22% (95% CI, 12%-34%) of patients treated with angiotensin II and placebo (p = 0.001), respectively. CONCLUSIONS: In patients with acute kidney injury requiring renal replacement therapy at study drug initiation, 28-day survival and mean arterial pressure response were higher, and rate of renal replacement therapy liberation was greater in the angiotensin II group versus the placebo group. These findings suggest that patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy may preferentially benefit from angiotensin II.
Source: Critical Care Medicine
Authors: James A. Tumlin, Raghavan Murugan, Adam M. Deane, Marlies Ostermann, Laurence W. Busse, Kealy R. Ham, Kianoush Kashani, Harold M. Szerlip, John R. Prowle, Azra Bihorac, Kevin W. Finkel, Alexander Zarbock, Lui G. Forni, Shannan J. Lynch, Jeff Jensen, Stew Kroll, Lakhmir S. Chawla, George F. Tidmarsh, Rinaldo Bellomo
Institutions: University of Pittsburgh, The Royal Melbourne Hospital, The University of Melbourne, St Thomas' Hospital, King's College London, Emory University, Regions Hospital, University of Minnesota, Mayo Clinic, Baylor University Medical Center, Queen Mary University of London, Royal London Hospital, William Harvey Research Institute, University of Florida Health, University of Florida, The University of Texas Health Science Center at Houston, University of Münster, University Hospital Münster, Royal Surrey County Hospital, University of Surrey, La Jolla Pharmaceutical (United States), Austin Hospital
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W2789446953