title: Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial.
abstract: BACKGROUND
  Acute kidney injury (AKI) is common in patients with sepsis and has been associated with high mortality rates. The provision of thiamine to patients with sepsis may reduce the incidence and severity of sepsis-related AKI and thereby prevent renal failure requiring renal replacement therapy (RRT).
  
  
  OBJECTIVE
  To test the hypothesis that thiamine supplementation mitigates kidney injury in septic shock.
  
  
  METHODS
  This was a secondary analysis of a single-center, randomized, double-blind trial comparing thiamine to placebo in patients with septic shock. Renal function, need for RRT, timing of hemodialysis catheter placement, and timing of RRT initiation were abstracted. The baseline creatinine and worst creatinine values between 3 and 24 hours, 24 and 48 hours, and 48 and 72 hours were likewise abstracted.
  
  
  RESULTS
  There were 70 patients eligible for analysis after excluding 10 patients in whom hemodialysis was initiated before study drug administration. Baseline serum creatinine in the thiamine group was 1.2 mg/dl (interquartile range, 0.8-2.5) as compared with 1.8 mg/dl (interquartile range, 1.3-2.7) in the placebo group (P = 0.3). After initiation of the study drug, more patients in the placebo group than in the thiamine group were started on RRT (eight [21%] vs. one [3%]; P = 0.04). In the repeated measures analysis adjusting for the baseline creatinine level, the worst creatinine levels were higher in the placebo group than in the thiamine group (P = 0.05).
  
  
  CONCLUSIONS
  In this post hoc analysis of a randomized controlled trial, patients with septic shock randomized to receive thiamine had lower serum creatinine levels and a lower rate of progression to RRT than patients randomized to placebo. These findings should be considered hypothesis generating and can be used as a foundation for further, prospective investigation in this area.
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine.
authors.forename: Ari
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: 2 Department of Emergency Medicine, and.|3 Research Center for Emergency Medicine, and.|4 Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.affiliation: 2 Department of Emergency Medicine, and.|5 Division of Critical Care, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: 2 Department of Emergency Medicine, and.|3 Research Center for Emergency Medicine, and.
authors.forename: Mathias
authors.initials: M
authors.lastname: Karlsson
authors.affiliation: 2 Department of Emergency Medicine, and.
authors.forename: Parth V
authors.initials: PV
authors.lastname: Patel
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine.|2 Department of Emergency Medicine, and.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020011:Protective Agents / Q000008:administration & dosage; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications*; D013831:Thiamine / Q000008:administration & dosage*
chemical_list: D020011:Protective Agents; D003404:Creatinine; D013831:Thiamine
keywords: beriberi; mitochondria; multiple organ failure; renal insufficiency; sepsis