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J. Clin. Med. 2018, 7(9), 274; https://doi.org/10.3390/jcm7090274

Norepinephrine Administration Is Associated with Higher Mortality in Dialysis Requiring Acute Kidney Injury Patients with Septic Shock

1
Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan North Road, Taipei 10449, Taiwan
2
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.7.Chung San South Road, Taipei 10002, Taiwan
3
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, No.7.Chung San South Road, Taipei 10002, Taiwan
4
Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Road, Taipei 11217, Taiwan
5
Department of Anesthesiology, National Taiwan University Hospital, No.7.Chung San South Road, Taipei 10002, Taiwan
6
Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan
7
Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40447, Taiwan
8
Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, 5. Fu-Hsing Street. Kuei Shan Hsiang, Taoyuan City 333, Taiwan
9
Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Road, Sanzhi District, New Taipei City 252, Taiwan
10
Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing St., Taipei 11031, Taiwan
11
Department of Medical Research, China Medical University Hospital, China Medical University, No.91, Hsueh-Shih Road, Taichung 40402, Taiwan
12
Mackay Junior College of Medicine, Nursing and Management, No.92, Shengjing Road, Taipei 11260, Taiwan
Membership of the NSARF Group is provided in the Acknowledgments.
Membership of the CAKS Group is provided in the Acknowledgments.
*
Author to whom correspondence should be addressed.
Received: 5 August 2018 / Revised: 7 September 2018 / Accepted: 9 September 2018 / Published: 12 September 2018
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Abstract

(1) Background: Norepinephrine (NE) is the first-line vasoactive agent used in septic shock patients; however, the effect of norepinephrine on dialysis-required septic acute kidney injury (AKI-D) patients is uncertain. (2) Methods: To evaluate the impact of NE on 90-day mortality and renal recovery in septic AKI-D patients, we enrolled patients in intensive care units from 30 hospitals in Taiwan. (3) Results: 372 patients were enrolled and were divided into norepinephrine users and non-users. After adjustment by Inverse probability of treatment weighted (IPTW), there was no significant difference of baseline comorbidities between the two groups. NE users had significantly higher 90-day mortality rate and using NE is a strong predictor of 90-day mortality in the multivariate Cox regression (HR = 1.497, p = 0.027) after adjustment. The generalized additive model disclosed norepinephrine alone exerted a dose–dependent effect on 90-day mortality, while other vasoactive agents were not. (4) Conclusion: Using norepinephrine in septic AKI-D patients is associated with higher 90-day mortality and the effect is dose-dependent. Further study to explore the potential mechanism is needed. View Full-Text
Keywords: critical care; vasoactive agents; norepinephrine; sepsis; acute kidney injury; dialysis critical care; vasoactive agents; norepinephrine; sepsis; acute kidney injury; dialysis
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Chen, Y.-Y.; Wu, V.-C.; Huang, W.-C.; Yeh, Y.-C.; Wu, M.-S.; Huang, C.-C.; Wu, K.-D.; Fang, J.-T.; Wu, C.-J.; The NSARF; CAKS Group. Norepinephrine Administration Is Associated with Higher Mortality in Dialysis Requiring Acute Kidney Injury Patients with Septic Shock. J. Clin. Med. 2018, 7, 274.

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