Search

Background Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods A consensus conference on the spectrum of lung-kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Conclusion The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung-kidney interactions to improve care processes and outcomes in critical illness., Author(s): Michael Joannidis [sup.1], Lui G. Forni [sup.2] [sup.3], Sebastian J. Klein [sup.1] [sup.4], Patrick M. Honore [sup.5], Kianoush Kashani [sup.6], Marlies Ostermann [sup.7], John Prowle [sup.8] [sup.9], Sean M. [...]

Author(s): Kianoush B. Kashani [sup.1] [sup.2], Antoine G. Schneider [sup.3], Zaccaria Ricci [sup.4] Author Affiliations: (1) grid.66875.3a, 0000 0004 0459 167X, Division of Nephrology and Hypertension, Department of Medicine, Mayo [...]

Author(s): Kianoush Kashani [sup.1] [sup.2] , Adeera Levin [sup.3] , Miet Schetz [sup.4] Author Affiliations: (1) 0000 0004 0459 167X, grid.66875.3a, Division of Pulmonary and Critical Care Medicine, Department of [...]

Purpose To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination. Methods All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR > 45 and eGFR [less than or equal to] 45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR [greater than or equal to] 60, 30-59, and Results A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34%, OR .88 (95% CI .75-1.05), p = .15), dialysis (2.0 vs. 1.7%, OR 1.20 (.66-2.17), p = .55), and mortality (12 vs. 14%, OR .87 (.69-1.10), p = .23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR > 45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5%, OR 2.72 (1.14-6.46), p = .0240) were observed in the contrast versus noncontrast group in the matched eGFR [less than or equal to] 45 subset. Conclusions Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR > 45. An increased risk of dialysis was observed in patients with pre-CT eGFR [less than or equal to] 45., Author(s): Jennifer S. McDonald [sup.1], Robert J. McDonald [sup.1], Eric E. Williamson [sup.1], David F. Kallmes [sup.2], Kianoush Kashani [sup.3] Author Affiliations: (1) 0000 0004 0459 167X, grid.66875.3a, Department of [...]