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Dewitte A, Labat A, Duvignaud PA, et al. High mean arterial pressure target to improve sepsis-associated acute kidney injury in patients with prior hypertension: a feasibility study. Ann Intensive Care. 2021;11(1):139doi: 10.1186/s13613-021-00925-2.
Dewitte, A., Labat, A., Duvignaud, P. A., Bouche, G., Joannes-Boyau, O., Ripoche, J., Hilbert, G., Gruson, D., Rubin, S., Ouattara, A., Boyer, A., & Combe, C. (2021). High mean arterial pressure target to improve sepsis-associated acute kidney injury in patients with prior hypertension: a feasibility study. Annals of intensive care, 11(1), 139. https://doi.org/10.1186/s13613-021-00925-2
Dewitte, Antoine, et al. "High mean arterial pressure target to improve sepsis-associated acute kidney injury in patients with prior hypertension: a feasibility study." Annals of intensive care vol. 11,1 (2021): 139. doi: https://doi.org/10.1186/s13613-021-00925-2
Dewitte A, Labat A, Duvignaud PA, Bouche G, Joannes-Boyau O, Ripoche J, Hilbert G, Gruson D, Rubin S, Ouattara A, Boyer A, Combe C. High mean arterial pressure target to improve sepsis-associated acute kidney injury in patients with prior hypertension: a feasibility study. Ann Intensive Care. 2021 Sep 22;11(1):139. doi: 10.1186/s13613-021-00925-2. PMID: 34553274; PMCID: PMC8458519.
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Ann Intensive Care. 2021 Sep 22;11(1):139. doi: 10.1186/s13613-021-00925-2.

High mean arterial pressure target to improve sepsis-associated acute kidney injury in patients with prior hypertension: a feasibility study.

Annals of intensive care

Antoine Dewitte, Aurore Labat, Pierre-Antoine Duvignaud, Gauthier Bouche, Olivier Joannes-Boyau, Jean Ripoche, Gilles Hilbert, Didier Gruson, Sébastien Rubin, Alexandre Ouattara, Alexandre Boyer, Christian Combe

Affiliations

  1. CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000, Bordeaux, France. [email protected].
  2. Univ. Bordeaux, CNRS, UMR 5164, ImmunoConcEpT, F-33000, Bordeaux, France. [email protected].
  3. CHU Bordeaux, Department of Nephrology-Transplantation-Dialysis-Apheresis, Hôpital Pellegrin, F-33000, Bordeaux, France.
  4. CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000, Bordeaux, France.
  5. The Anticancer Fund, 1853, Strombeek-Bever, Belgium.
  6. Univ. Bordeaux, INSERM, UMR 1026, F-33000, Bordeaux, France.
  7. CHU Bordeaux, Medical Intensive Care Unit, Hôpital Pellegrin, F-33000, Bordeaux, France.
  8. Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600, Pessac, France.

PMID: 34553274 PMCID: PMC8458519 DOI: 10.1186/s13613-021-00925-2

Abstract

BACKGROUND: The optimal mean arterial pressure (MAP) in cases of septic shock is still a matter of debate in patients with prior hypertension. An MAP between 75 and 85 mmHg can improve glomerular filtration rate (GFR) but its effect on tubular function is unknown. We assessed the effects of high MAP level on glomerular and tubular renal function in two intensive care units of a teaching hospital. Inclusion criteria were patients with a history of chronic hypertension and developing AKI in the first 24 h of septic shock. Data were collected during two 6 h periods of MAP regimen administered consecutively after haemodynamic stabilisation in an order depending on the patient's admission unit: a high-target period (80-85 mmHg) and a low-target period (65-70 mmHg). The primary endpoint was the creatinine clearance (CrCl) calculated from urine and serum samples at the end of each MAP period by the UV/P formula.

RESULTS: 26 patients were included. Higher urine output (+0.2 (95%:0, 0.4) mL/kg/h; P = 0.04), urine sodium (+6 (95% CI 0.2, 13) mmol/L; P = 0.04) and lower serum creatinine (- 10 (95% CI - 17, - 3) µmol/L; P = 0.03) were observed during the high-MAP period as compared to the low-MAP period, resulting in a higher CrCl (+25 (95% CI 11, 39) mL/mn; P = 0.002). The urine creatinine, urine-plasma creatinine ratio, urine osmolality, fractional excretion of sodium and urea showed no significant variation. The KDIGO stage at inclusion only interacted with serum creatinine variation and low level of sodium excretion at inclusion did not interact with these results.

CONCLUSIONS: In the early stage of sepsis-associated AKI, a high-MAP target in patients with a history of hypertension was associated with a higher CrCl, but did not affect the kidneys' ability to concentrate urine, which may reflect no effect on tubular function.

© 2021. The Author(s).

Keywords: Acute kidney injury; Blood pressure; Intensive care; Kidney concentrating ability; Norepinephrine; Septic shock

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