The effects of vasopressin on acute kidney injury in septic shock

Gordon, Anthony C., Russell, James A., Walley, Keith R., Singer, Joel, Ayers, Deiter, Storms, Michelle M., Holmes, Cheryl L., Hebert, Paul C., Cooper, D. James, Mehta, Sangeeta, Granton, John T., Cook, Deborah J. and Presneill, Jeffrey J. (2010) The effects of vasopressin on acute kidney injury in septic shock. Intensive Care Medicine, 36 1: 83-91. doi:10.1007/s00134-009-1687-x


Author Gordon, Anthony C.
Russell, James A.
Walley, Keith R.
Singer, Joel
Ayers, Deiter
Storms, Michelle M.
Holmes, Cheryl L.
Hebert, Paul C.
Cooper, D. James
Mehta, Sangeeta
Granton, John T.
Cook, Deborah J.
Presneill, Jeffrey J.
Title The effects of vasopressin on acute kidney injury in septic shock
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 0342-4642
1432-1238
Publication date 2010-01
Sub-type Article (original research)
DOI 10.1007/s00134-009-1687-x
Volume 36
Issue 1
Start page 83
End page 91
Total pages 9
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Formatted abstract
Objective: To compare the effects of vasopressin versus norepinephrine infusion on the outcome of kidney injury in septic shock.
Design and setting: Post-hoc analysis of the multi-center double-blind randomized controlled trial of vasopressin versus norepinephrine in adult patients who had septic shock (VASST).
Patients and intervention: Seven hundred seventy-eight patients were randomized to receive a blinded infusion of either low-dose vasopressin (0.01–0.03 U/min) or norepinephrine infusion (5–15 μg/min) in addition to open-label vasopressors and were included in the outcome analysis. All vasopressors were titrated and weaned to maintain a target blood pressure.
Measurement and results: RIFLE criteria for acute kidney injury were used to compare the effects of vasopressin versus norepinephrine. In view of multiple simultaneous comparisons, a p value of 0.01 was considered statistically significant. Kidney injury was present in 464 patients (59.6%) at study entry. In patients in the RIFLE “Risk” category (n = 106), vasopressin as compared with norepinephrine was associated with a trend to a lower rate of progression to renal “Failure” or “Loss” categories (20.8 vs. 39.6%, respectively, p = 0.03), and a lower rate of use of renal replacement therapy (17.0 vs. 37.7%, p = 0.02). Mortality rates in the “Risk” category patients treated with vasopressin compared to norepinephrine were 30.8 versus 54.7%, p = 0.01, but this did not reach significance in a multiple logistic regression analysis (OR = 0.33, 99% CI 0.10–1.09, p = 0.02). The interaction of treatment group and RIFLE category was significant in predicting mortality.
Conclusions: Vasopressin may reduce progression to renal failure and mortality in patients at risk of kidney injury who have septic shock.
Keyword Sepsis
Kidney failure
Vasopressins
Septic shock
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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