• James A Tumlin, Raghavan Murugan, Adam M Deane, Marlies Ostermann, Laurence W Busse, Kealy R Ham, Kianoush Kashani, Harold M Szerlip, John R Prowle, Azra Bihorac, Kevin W Finkel, Alexander Zarbock, Lui G Forni, Shannan J Lynch, Jeff Jensen, Stew Kroll, Lakhmir S Chawla, George F Tidmarsh, Rinaldo Bellomo, and Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) Investigators.
• University of Tennessee College of Medicine, Chattanooga TN.
• Crit. Care Med. 2018 Jun 1; 46 (6): 949-957.

ObjectiveAcute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy.DesignPost hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial.SettingICUs.PatientsPatients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively).InterventionsIV angiotensin II or placebo.Measurements And Main ResultsPrimary end point: survival through day 28; secondary outcomes included renal recovery through day 7 and increase in mean arterial pressure from baseline of ≥ 10 mm Hg or increase to ≥ 75 mm Hg at hour 3. Survival rates through day 28 were 53% (95% CI, 38%-67%) and 30% (95% CI, 19%-41%) in patients treated with angiotensin II and placebo (p = 0.012), respectively. By day 7, 38% (95% CI, 25%-54%) of angiotensin II patients discontinued RRT versus 15% (95% CI, 8%-27%) placebo (p = 0.007). Mean arterial pressure response was achieved in 53% (95% CI, 38%-68%) and 22% (95% CI, 12%-34%) of patients treated with angiotensin II and placebo (p = 0.001), respectively.ConclusionsIn patients with acute kidney injury requiring renal replacement therapy at study drug initiation, 28-day survival and mean arterial pressure response were higher, and rate of renal replacement therapy liberation was greater in the angiotensin II group versus the placebo group. These findings suggest that patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy may preferentially benefit from angiotensin II.

18 keywords...

hide…