Kidney Week

Abstract: PUB027

Use of Vasopressors in Patients with AKI on Continuous Kidney Replacement Therapy

Session Information

• Publication Only

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Ramesh, Ambika, West Virginia University, Morgantown, West Virginia, United States

Ambika Ramesh, DO

• Doddi, Akshith, West Virginia University, Morgantown, West Virginia, United States

Akshith Doddi, MD

• Abbasi, Aisha, West Virginia University, Morgantown, West Virginia, United States

Aisha Abbasi, MD

• Al-Mamun, Mohammad A., West Virginia University School of Pharmacy, Morgantown, West Virginia, United States

Mohammad A. Al-Mamun, PhD

• Sakhuja, Ankit, West Virginia University, Morgantown, West Virginia, United States

Ankit Sakhuja, MBBS, MS, FASN

• Shawwa, Khaled, West Virginia University, Morgantown, West Virginia, United States

Khaled Shawwa, MD, MS, FASN

Background

To investigate whether use of any specific vasopressor is associated with increased mortality or adverse outcomes (kidney recovery and hypervolemia) in patients with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT).

Methods

Patients were included if they had AKI and underwent CKRT between 1/1/2012-1/1/2021 at a tertiary academic hospital. Cox proportional hazard model was used to assess the relationship between time-dependent vasopressors and in-hospital mortality. The relationship between vasopressors and daily fluid balance was assessed using Generalized Estimation Equation.

Results

There were 641 patients with AKI that required CKRT. In-hospital mortality occurred in 318 (49.6%) patients. Those who died were older (63 vs 57 years), required mechanical ventilation at time of CKRT (80% vs 63%), had higher SOFA score (10.6 vs 9) and lactate (6 vs 3.3 mmol/L). In multivariable model, increasing doses of norepinephrine (NE) [HR 4.4 (95% CI: 2.3-7, p<0.001)] per 0.02 mcg/min/kg and vasopressin [HR 2.6 (95% CI: 1.9-3.2, p=0.01)] per 0.02 unit/min during CKRT were associated with in-hospital mortality. Dobutamine, epinephrine and phenylephrine were not associated with in-hospital mortality. Baseline vasopressor values measured at CKRT initiation were not associated with in-hospital mortality. The model was adjusted for vasopressor doses and fluid balance prior to CKRT initiation, time-dependent daily fluid balance and vasopressor doses, SOFA score, septic shock, age, sex, Charlson comorbidity index, mechanical ventilation and baseline lactate. NE was the most commonly used vasopressor (18% of the time). All vasopressors, except dobutamine, were associated with positive daily fluid balance. Phenylephrine had the lowest coefficient 0.6 (0.45-0.73) liters per 1 mcg/kg/min increase, whereas the other vasopressors ranged between 2.4-4.3 L per 1-unit increase. Mean values of individual vasopressors were not associated with doubling of creatinine or persistent need of dialysis at day 30.

Conclusion

The associations between norepinephrine and vasopressin with in-hospital mortality could be related to their common use in this cohort.