Delayed initiation of adequate antibiotic treatment and transfusion of blood products are among the risk factors associated with development of acute kidney injury (AKI) in patients with septic shock, a study showed.

Other predictors include intra-abdominal sepsis, use of an ACE inhibitor or angiotensin receptor blocker (ARB), and body mass index (BMI), according to a report in the Clinical Journal of the American Society of Nephrology (2011;6:1744-1751).

Higher baseline glomerular filtration rate and adequate goal-directed resuscitation were associated with a decreased risk of AKI.

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Rodrigo Cartin-Ceba, MD, and colleagues at Mayo Clinic in Rochester, Minn., studied 390 patients admitted to a medical intensive care unit. AKI, which was defined according to RIFLE criteria, developed in 237 patients (61%). After adjusting for confounders, the researchers found that each hour of delay in initiation of adequate antibiotics was associated with a significant 3% increased risk of AKI. Each 1 kg/m2 increment in BMI was associated with a 2% increased risk. Use of an ACE inhibitor or ARB was associated with a significant 88% increased risk. Intra-abdominal sepsis and blood product transfusion increased AKI risk twofold and fivefold, respectively.

Additionally, each 1 mL/min/1.73 m2 increment in baseline GFR was associated with a 1% decreased risk of AKI. Adequate goal-directed resuscitation was associated with a 47% decreased risk.

Development of AKI was associated with significantly increased hospital mortality. Forty-nine percent of those who developed AKI died in the hospital compared with 34% of patients who did not develop AKI.

The pathophysiology of septic AKI is considered to be distinct from that of AKI of different origin, the authors noted. AKI in sepsis is attributed to both hemodynamic and inflammatory/immune/apoptotic mechanisms, all of which are modifiable with adequate resuscitation and antibiotic administration, they wrote.

“Health care delivery factors may be potentially modified, thus contributing to the reduction of the high incidence of AKI in patients with sepsis,” the authors concluded.