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An AKI project for critically ill cancer patients Peter Pickkers Department of Intensive Care Medicine Radboud university medical centre, Nijmegen Paris, March 28th 2017 Intensive Care Intensive Care Intensive Care Remaining questions • Difference in AKI kinetics per cause of AKI (cancer patients different from the ‘regular’ critically ill patient) • Effect of transition to other AKI severity category on outcome • Outcome AKI vs patients admitted with Chronic Renal Failure • Changes in ICU admission policy 2006-2017 • Role of biomarkers? Intensive Care Evolution of acute kidney injury Intensive Care Evolution of acute kidney injury Intensive Care Evolution of acute kidney injury Intensive Care Evolution of acute kidney injury Intensive Care Hospital mortality Intensive Care Hospital mortality • Recovery from AKI-F: 15-20% lower mortality Intensive Care Hospital mortality • Recovery from AKI-F: 15-20% lower mortality Intensive Care Hospital mortality • Recovery from AKI-F: 15-20% lower mortality • However, still twice as high as patients with No-AKI at all Intensive Care Intensive Care Baseline demographics • • • • • • • • • • Age Male sex Comorbidities Cause underlying immune suppression High BMI Diabetes Chronic liver disease Chronic heart disease Chronic kidney impairment Creatinine, baseline Intensive Care Aetiological risk factors • • • • • • • • • Dehydration Hypotension or shock Cardiac Liver Acute kidney disease Urinary obstruction Infection, sepsis Systemic diseases Nephrotoxic agents Intensive Care Other organ failures at acute kidney injury confirmation day • • • • • • • Pulmonary Cardiovascular Neurological Hepatic Haematological None Number of organ failures: 0, 1, 2, 3 Intensive Care At acute kidney injury diagnosis • • • • • • • • • sCr (μmol/L) BUN (mmol/L) Urine output past 24 h (mL) Criteria for acute kidney injury diagnosis sCr (alone) Oliguria (alone) sCr and urine output Stage at diagnosis (1, 2, 3) Biomarkers? Intensive Care Multivariate analyses that determines renal and clinical outcome in these patients, including • • • • • • • • • Age Hospital-acquired acute kidney injury Number of organ failures Sepsis Use of antibiotics Oliguria Chronic kidney disease Need for dialysis Limitations of treatment, including RRT Intensive Care
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