Outcomes in patients with vasodilatory shock and renal replacement therapy treated with intravenous angiotensin II

Tumlin, J.A., Murugan, R., Deane, A.M., Ostermann, M., Busse, L.W., Ham, K.R., Kashani, K., Szerlip, H.M., Prowle, J.R., Bihorac, A. et al, Finkel, K.W., Zarbock, A., Forni, Lui G., Lynch, S.J., Jensen, J., Kroll, S., Chawla, L.S., Tidmarsh, G.F. and Bellomo, R. (2018) Outcomes in patients with vasodilatory shock and renal replacement therapy treated with intravenous angiotensin II Critical Care Medicine, 46 (6). pp. 949-957.

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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.

Item Type:	Article
Divisions :	Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :	Name Email ORCID Tumlin, J.A. Murugan, R. Deane, A.M. Ostermann, M. Busse, L.W. Ham, K.R. Kashani, K. Szerlip, H.M. Prowle, J.R. Bihorac, A. Finkel, K.W. Zarbock, A. Forni, Lui G. l.forni@surrey.ac.uk Lynch, S.J. Jensen, J. Kroll, S. Chawla, L.S. Tidmarsh, G.F. Bellomo, R.
Date :	June 2018
DOI :	10.1097/CCM.0000000000003092
Copyright Disclaimer :	Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Uncontrolled Keywords :	Acute kidney injury; Sepsis; Vasodilatory shock; Angiotensin II,; Renal replacement therapy; Acute renal disease
Depositing User :	Diane Maxfield
Date Deposited :	24 Oct 2019 15:06
Last Modified :	24 Oct 2019 15:06
URI:	http://epubs.surrey.ac.uk/id/eprint/852721

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