• Christopher J Tignanelli, Arek J Wiktor, Cory J Vatsaas, Gaurav Sachdev, Michael Heung, Pauline K Park, Krishnan Raghavendran, and Lena M Napolitano.
• Christopher J. Tignanelli is a surgical critical care fellow, University of Michigan Health System, Ann Arbor, Michigan. Arek J. Wiktor is an assistant professor of surgery, University of Colorado, Denver, Colorado. Cory J. Vatsaas is an assistant professor of surgery, Duke University Health System, Durham, North Carolina. Gaurav Sachdev is an assistant professor of surgery, Carolinas Medical Center, Charlotte, North Carolina. Michael Heung is an associate professor of medicine, Division of Nephrology, University of Michigan Health System. Pauline K. Park and Krishnan Raghavendran are professors of surgery, University of Michigan Health System. Lena M. Napolitano is professor of surgery, division chief of acute care surgery, director of trauma and surgical critical care, and associate chair of the Department of Surgery, University of Michigan Health System.
• Am. J. Crit. Care. 2018 Jan 1; 27 (1): 67-73.

BackgroundThe incidence and long-term outcomes of acute kidney injury in patients with severe acute respiratory distress syndrome (ARDS) due to influenza A(H1N1) pdm09 virus (pH1N1) have not been examined.ObjectiveTo assess long-term renal recovery in patients with acute kidney injury and severe ARDS due to pH1N1.MethodsA retrospective observational cohort study of adults with severe pH1N1-associated ARDS admitted to a tertiary referral center. Baseline characteristics, acute kidney injury stage, continuous renal replacement therapy (CRRT), intermittent hemodialysis, extracorporeal membrane oxygenation, survival, and renal recovery (defined as dialysis independence) were evaluated.ResultsFifty-seven patients, most with stage 3 acute kidney injury, were included. The 53% mortality rate among the 38 patients requiring CRRT was significantly higher than the 0% mortality rate among the 19 patients not requiring CRRT or intermittent hemodialysis. Increased duration of CRRT was not significantly associated with decreased survival. Fifteen CRRT patients required transition to intermittent hemodialysis. Of the CRRT patients who survived, 94% experienced renal recovery. Extracorporeal membrane oxygenation was instituted in 17 patients; 15 of these patients required CRRT.ConclusionsAcute kidney injury is common in patients with severe ARDS caused by pH1N1 infection. CRRT is a significant risk factor for increased mortality, but most patients who survived experienced full renal recovery.©2018 American Association of Critical-Care Nurses.

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