title: The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock.
abstract: BACKGROUND
  Septic shock is a common cause of acute kidney injury (AKI), and fluid resuscitation is a major part of therapy.
  
  
  OBJECTIVE
  To determine if structured resuscitation designed to alter fluid, blood, and vasopressor use affects the development or severity of AKI or outcomes.
  
  
  METHODS
  Ancillary study to the ProCESS (Protocolized Care for Early Septic Shock) trial of alternative resuscitation strategies (two protocols vs. usual care) for septic shock.
  
  
  RESULTS
  We studied 1,243 patients and classified AKI using serum creatinine and urine output. We determined recovery status at hospital discharge, examined rates of renal replacement therapy and fluid overload, and measured biomarkers of kidney damage. Among patients without evidence of AKI at enrollment, 37.6% of protocolized care and 38.1% of usual care patients developed kidney injury (P = 0.90). AKI duration (P = 0.59) and rates of renal replacement therapy did not differ between study arms (6.9% for protocolized care and 4.3% for usual care; P = 0.08). Fluid overload occurred in 8.3% of protocolized care and 6.3% of usual care patients (P = 0.26). Among patients with severe AKI, complete and partial recovery was 50.7 and 13.2% for protocolized patients and 49.1 and 13.4% for usual care patients (P = 0.93). Sixty-day hospital mortality was 6.2% for patients without AKI, 16.8% for those with stage 1, and 27.7% for stages 2 to 3.
  
  
  CONCLUSIONS
  In patients with septic shock, AKI is common and associated with adverse outcomes, but it is not influenced by protocolized resuscitation compared with usual care.
authors.affiliation: 1 CRISMA Center, Department of Critical Care Medicine.|2 Center for Critical Care Nephrology.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: 2 Center for Critical Care Nephrology.|3 Department of Medicine, Divisions of Intensive Care Medicine and Nephrology, Veterans Affairs Medical Center, Washington, DC.
authors.forename: Lakhmir S
authors.initials: LS
authors.lastname: Chawla
authors.affiliation: 1 CRISMA Center, Department of Critical Care Medicine.|4 Graduate School of Public Health.
authors.forename: Christopher
authors.initials: C
authors.lastname: Keener
authors.affiliation: 2 Center for Critical Care Nephrology.|5 Department of Anesthesia, Penn State Hershey Medical Center, Hershey, Pennsylvania; and.
authors.forename: Kai
authors.initials: K
authors.lastname: Singbartl
authors.affiliation: 2 Center for Critical Care Nephrology.|7 Renal-Electrolyte Division, Department of Medicine, and.|6 Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Palevsky
authors.affiliation: 1 CRISMA Center, Department of Critical Care Medicine.
authors.forename: Francis L
authors.initials: FL
authors.lastname: Pike
authors.affiliation: 8 Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
authors.affiliation: 1 CRISMA Center, Department of Critical Care Medicine.
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.affiliation: 1 CRISMA Center, Department of Critical Care Medicine.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017582:Renal Replacement Therapy; D012151:Resuscitation / Q000379:methods*; D012772:Shock, Septic / Q000150:complications*
chemical_list: D015415:Biomarkers
keywords: acute kidney injury; early goal-directed therapy; resuscitation; sepsis; septic shock