Abstract
Background
Acute kidney injury (AKI) is common after cardiac arrest and targeted temperature
management (TTM). The impact of different lengths of cooling on the development of
AKI has not been well studied. In this study of patients included in a randomised
controlled trial of TTM at 33 °C for 24 versus 48 h after cardiac arrest (TTH48 trial),
we examined the influence of prolonged TTM on AKI and the incidence and factors associated
with the development of AKI. We also examined the impact of AKI on survival.
Methods
This study was a sub-study of the TTH48 trial, which included patients cooled to 33 ± 1 °C
after out-of-hospital cardiac arrest for 24 versus 48 h. AKI was classified according
to the KDIGO AKI criteria based on serum creatinine and urine output collected until
ICU discharge for a maximum of seven days. Survival was followed for up to six months.
The association of admission factors on AKI was analysed with multivariate analysis
and the association of AKI on mortality was analysed with Cox regression using the
time to AKI as a time-dependent covariate.
Results
Of the 349 patients included in the study, 159 (45.5%) developed AKI. There was no
significant difference in the incidence, severity or time to AKI between the 24- and
48-h groups. Serum creatinine values had significantly different trajectories for
the two groups with a sharp rise occurring during rewarming. Age, time to return of
spontaneous circulation, serum creatinine at admission and body mass index were independent
predictors of AKI. Patients with AKI had a higher mortality than patients without
AKI (hospital mortality 36.5% vs 12.5%, p < 0.001), but only AKI stages 2 and 3 were independently associated with mortality.
Conclusions
We did not find any association between prolonged TTM at 33 °C and the risk of AKI
during the first seven days in the ICU. AKI is prevalent after cardiac arrest and
TTM and occurs in almost half of all ICU admitted patients and more commonly in the
elderly, with an increasing BMI and longer arrest duration. AKI after cardiac arrest
is an independent predictor of time to death.
Abbreviations:
AKI (acute kidney injury), BMI (body mass index), CKD (chronic kidney disease), GFR (glomerular filtration ratio), KDIGO (kidney disease improving global outcome), OHCA (out-of-hospital cardiac arrest), ROSC (return of spontaneous circulation), RRT (renal replacement therapy), sCr (serum creatinine), sUr (serum uread), TTM (targeted temperature management), UO (urine output)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acute kidney injury after cardiac arrest: a systematic review and meta-analysis of clinical studies.Minerva Anestesiol. 2016; 82: 989-999
- Renal function after out-of-hospital cardiac arrest; the influence of temperature management and coronary angiography, a post hoc study of the target temperature management trial.Crit Care. 2019; 23: 163
- Acute kidney injury after cardiac arrest.Resuscitation. 2012; 83: 721-727
- The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database.Crit Care. 2016; 20: 368
- Kidney-brain crosstalk in the acute and chronic setting.Nat Rev Nephrol. 2015; 11: 707-719
- Therapeutic hypothermia and prevention of acute kidney injury: a meta-analysis of randomized controlled trials.Resuscitation. 2012; 83: 159-167
- KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract. 2012; 120: c179-c184
- Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial.JAMA. 2017; 318: 341-350
- A statistical analysis protocol for the time-differentiated target temperature management after out-of-hospital cardiac arrest (TTH48) clinical trial.Scand J Trauma Resusc Emerg Med. 2016; 24: 138
- A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.Ann Intern Med. 1999; 130: 461-470
- State-of the-art review on the renal and visceral protection during open thoracoabdominal aortic aneurysm repair.J Vis Surg. 2018; 4: 31
- Therapeutic hypothermia in deceased organ donors and kidney-graft function.N Engl J Med. 2015; 373: 2687
- The effect of whole-body cooling on renal function in post-cardiac arrest patients.BMC Nephrol. 2017; 18: 376
- Prolonged induced hypothermia in hemorrhagic shock is associated with decreased muscle metabolism: a nuclear magnetic resonance-based metabolomics study.Shock. 2014; 41: 79-84
- Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria.BMC Nephrol. 2017; 18: 70
- Use of renal replacement therapy after out-of-hospital cardiac arrest in Denmark 2005–2013.Scand Cardiovasc J. 2018; 52: 238-243
- Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study.Acta Anaesthesiol Scand. 2016; 60: 1170-1181
- Guidelines for post-resuscitation care should include management of acute kidney injury and use of renal replacement therapy.Resuscitation. 2018; 126: e14
- Initiation strategies for renal-replacement therapy in the intensive care unit.N Engl J Med. 2016; 375: 122-133
- Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort.Intensive Care Med. 2015; 41: 1273-1280
- Acute kidney injury after cardiac arrest.Crit Care. 2015; 19: 169
- Obesity, acute kidney injury, and mortality in critical illness.Crit Care Med. 2016; 44: 328-334
- Obesity, acute kidney injury and mortality in patients with sepsis: a cohort analysis.Ren Fail. 2018; 40: 120-126
- Are there modifiable risk factors to improve AKI?.Biomed Res Int. 2017; 2017: 5605634
- Impact of acute kidney injury on neurological outcome and long-term survival after cardiac arrest – a 10year observational follow up.J Crit Care. 2018; 47: 254-259
- Shock duration after resuscitation is associated with occurrence of post-cardiac arrest acute kidney injury.J Korean Med Sci. 2015; 30: 802-807
- Recovery from acute kidney injury as a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest.Crit Care. 2019; 23: 256
- Creatinine-based definitions: from baseline creatinine to serum creatinine adjustment in intensive care.Crit Care. 2016; 20: 69
Article info
Publication history
Published online: February 19, 2020
Accepted:
January 22,
2020
Received in revised form:
December 27,
2019
Received:
October 6,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V.
