Acute Kidney Events in Intensive Care Patients

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 967

Special Issue Editor


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Guest Editor
1. Intensive Care Unit Département, Lapeyronie University Hospital Montpellier, 34295 Montpellier, France
2. Phymedexp, Faculty of Medicine, Université de Montpellier, Inserm, Centre National de Recherche Scientifique (CNRS), CHRU de Montpellier, 34295 Montpellier, France
Interests: critical care; septic shock; COVID-19 infection; acute kidney injury; community-acquired pneumonia

Special Issue Information

Dear Colleagues,

As guest editor of a Special Issue of the Journal of Clinical Medicine entitled "Acute Kidney Events in Intensive Care Patients", I would like to invite you to contribute.

The aim of this Issue is to report the most recent data on renal function and its possible deterioration in critically ill patients. The kidney is a central organ in the management of intensive care patients, and thus deserves a great deal of attention with the sole aim of improving the prognosis of these patients.

In patients admitted to intensive care units (ICUs), adverse renal events frequently occur, significantly impacting mortality and morbidity. Acute kidney injury (AKI) is the most common adverse renal event. In fact, AKI occurs in almost 50% of these patients, leading not only to an increased risk of mortality, but also to deleterious systemic effects in survivors, predisposing them to cardiovascular disease and chronic kidney disease.

The organ failures associated with the development of AKI, and the acute complications that ensue, have prompted extensive research into its early identification, with the aim of improving the outcome of the critically ill. Variations in serum creatinine and urine output define AKI, with small variations in these parameters being associated with worse outcomes. As a result, a number of studies have focused on identifying blood and urine biomarkers, biomarkers of function or stress, in order to earlier diagnose impaired renal function in ICU settings.

Major adverse renal events (MAKE), including death, the need for renal replacement therapy (RRT), and worsening renal function, are now recognized as key determinants of patient outcome, particularly in ICUs. After much debate, the indication of RRT in AKI is now well established. This review provides an opportunity to review these indications in detail, and the arguments on which they are based.

Also, patients suffering from AKI treated with RRT would be confronted with serious associated adverse effects, the occurrence of which must be prevented through choosing and controlling the appropriate modality while being aware of its deleterious effects.

The short- and long-term prognosis of critical patients with ARF depends largely on the severity of the condition. Death is the most serious adverse effect, but surviving patients will experience other adverse effects such as cardiovascular events and chronic impairment of renal function. This review will take stock of the medium- and long-term deleterious effects associated with the occurrence of AKI.

Prof. Dr. Kada Klouche
Guest Editor

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Keywords

  • acute kidney events
  • ICU
  • critically ill
  • RRT
  • outcome
  • acute kidney disease
  • chronic kidney disease
  • bi-omarkers

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Published Papers (2 papers)

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Research

12 pages, 2281 KiB  
Article
Short-Term Reactions to Oliguria in Critically Ill Patients: A Retrospective Cohort Study
by Dekel Stavi, Amir Gal Oz, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Yael Lichter, Ron Wald and Noam Goder
J. Clin. Med. 2025, 14(9), 3107; https://doi.org/10.3390/jcm14093107 - 30 Apr 2025
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Abstract
Background/Objective: Oliguria is common in critically ill patients and may indicate impaired kidney perfusion or acute injury, contributing to increased mortality. Effective management is essential to improve outcomes. To assess clinician reactions to oliguria and evaluate the effectiveness of fluid bolus and [...] Read more.
Background/Objective: Oliguria is common in critically ill patients and may indicate impaired kidney perfusion or acute injury, contributing to increased mortality. Effective management is essential to improve outcomes. To assess clinician reactions to oliguria and evaluate the effectiveness of fluid bolus and furosemide interventions. Methods: A retrospective cohort study was conducted using ICU data from a single center (2017–2023). Oliguria was defined as two consecutive hours of urine output < 20 mL/h following at least three hours > 20 mL/h. Clinicians’ reactions within four hours were categorized as no intervention, fluid bolus (>250 mL), or furosemide administration. Outcomes included urine output, fluid balance, and serum creatinine. Results: Among 4987 oliguria episodes, 4007 events in 1825 patients were analyzed: no reaction (2536), fluid bolus (923), and furosemide (548). Furosemide significantly increased urine output (53.9 to 75.3 mL/h, p < 0.001), while fluid bolus had no significant effect. Resolution of oliguria (mean urine output > 40 mL/h for 5 h post-intervention) was more frequent with furosemide (66.4%) than with fluid bolus (28.4%) or no reaction (27.6%) (p < 0.001). Treatment choices varied significantly among ICU attendings (p < 0.001). Conclusions: Furosemide was more effective than fluid bolus or no treatment in improving urine output and resolving oliguria. The observed variation in clinician practices underscores the need for standardized management protocols to enhance patient care. Full article
(This article belongs to the Special Issue Acute Kidney Events in Intensive Care Patients)
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10 pages, 364 KiB  
Article
Risk Factors for Postoperative Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery
by Piotr Duchnowski and Witold Śmigielski
J. Clin. Med. 2024, 13(24), 7811; https://doi.org/10.3390/jcm13247811 - 20 Dec 2024
Cited by 2 | Viewed by 588
Abstract
Background: Postoperative acute kidney injury (AKI) in patients undergoing heart valve surgery is a common complication requiring special treatment, including renal replacement therapy (RRT). Effective prevention remains the most effective tool to reduce this important clinical problem. The aim of the study was [...] Read more.
Background: Postoperative acute kidney injury (AKI) in patients undergoing heart valve surgery is a common complication requiring special treatment, including renal replacement therapy (RRT). Effective prevention remains the most effective tool to reduce this important clinical problem. The aim of the study was to evaluate the predictive abilities of selected perioperative parameters in predicting AKI requiring RRT in the early postoperative period in patients undergoing cardiac valve surgery. Methods: Prospective study on a group of patients undergoing cardiac valve surgery. The primary endpoint was postoperative AKI requiring RRT. The secondary endpoint was death in the RRT group. Logistic regression analysis was used to assess which variables predicted the primary and secondary endpoints. Results: 603 patients were included in the study. The primary endpoint occurred in 43 patients. At multivariable analysis, age (p < 0.001), preoperative CRP level (p = 0.007), troponin T measured one day after surgery (TnT II) (p < 0.001) and prolonged postoperative use of catecholamines (p = 0.001) were independent predictors of the primary endpoint. In turn, death in the group of patients requiring RRT occurred in 32 patients. Age (p < 0.001), preoperative CRP level (p = 0.002), TnT II (p = 0.009), and prolonged postoperative use of catecholamines (p = 0.001) remained independent predictors of the secondary endpoint. Conclusions: The results of this study indicate that older age, elevated values of preoperative levels of CRP, as well as increasing levels of postoperative troponin T and the need for a prolonged supply of catecholamines, are independent predictors of postoperative AKI requiring RRT as well as death. Accurate identification of patients at increased postoperative risk of AKI could facilitate preoperative patient informed consent and optimize the process of qualification and cardiac surgical treatment. Full article
(This article belongs to the Special Issue Acute Kidney Events in Intensive Care Patients)
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