No Kidney Failure Improvement With Vasopressin in Septic Shock
No improvement in kidney failure-free days versus norepinephrine in adults with septic shock.
(HealthDay News) -- Among adults with septic shock, early use of vasopressin does not improve the number of kidney failure-free days versus norepinephrine, according to a study published in the Journal of the American Medical Association.
Anthony C. Gordon, MD, from Imperial College London, and colleagues compared the effect of early vasopressin versus norepinephrine on kidney failure. Adult patients with septic shock requiring vasopressors were enrolled and randomized to vasopressin and hydrocortisone (101 patients), vasopressin and placebo (104 patients), norepinephrine and hydrocortisone (101 patients), or norepinephrine and placebo (103 patients).
The researchers found that 57.0% of survivors in the vasopressin group and 59.2% in the norepinephrine group never developed kidney failure (difference, −2.3% [95% confidence interval (CI), −13.0 to 8.5%]). For patients who did not survive, who experienced kidney failure, or both, the median number of kidney failure-free days was 9 days in the vasopressin group and 13 days in the norepinephrine group (difference, −4 days [95% CI, −11 to 5]). The vasopressin group had less use of renal replacement therapy (25.4 vs 35.3%; difference, −9.9% [95% CI, −19.3 to −0.6%]). Just over 10% (10.7%) had a serious adverse event in the vasopressin group compared to 8.3% in the norepinephrine group (difference, 2.5% [95% CI, −3.3 to 8.2%]).
"Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further," the authors write.
One author disclosed financial ties to the pharmaceutical industry.
1. Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. JAMA. 2016;316(5):509-518. doi:10.1001/jama.2016.10485.