Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II.
Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II.
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DOI：
10.1097/ccm.0000000000003092
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发表时间：
2018-06
影响因子：
8.8
通讯作者：
Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) Investigators
中科院分区：
文献类型：
--
作者：
Tumlin JA;Murugan R;Deane AM;Ostermann M;Busse LW;Ham KR;Kashani K;Szerlip HM;Prowle JR;Bihorac A;Finkel KW;Zarbock A;Forni LG;Lynch SJ;Jensen J;Kroll S;Chawla LS;Tidmarsh GF;Bellomo R;Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) Investigators
补充数字内容可在文本中找到。严重血管扩张性休克患者需要肾脏替代治疗的急性肾损伤与不良预后相关。血管紧张素II治疗可能有助于这些患者在不降低肾内氧合的情况下恢复肾功能。我们分析了血管紧张素II对需要肾脏替代治疗的急性肾损伤结果的影响。血管紧张素II治疗高输出休克3试验的事后分析。icu。急性肾损伤患者在开始血管紧张素II或安慰剂时接受肾脏替代治疗（n = 45和n = 60）。静脉注射血管紧张素II或安慰剂。主要终点：存活至第28天；次要结局包括第7天肾脏恢复，平均动脉压从基线升高≥10 mm Hg或在第3小时升高至≥75 mm Hg。在接受血管紧张素II和安慰剂治疗的患者中，第28天的生存率分别为53% （95% CI, 38%-67%）和30% (95% CI, 19%-41%) （p = 0.012）。到第7天，38% （95% CI, 25%-54%）的血管紧张素II患者停止RRT治疗，而15% （95% CI, 8%-27%）的安慰剂患者停止RRT治疗（p = 0.007）。在接受血管紧张素II和安慰剂治疗的患者中，平均动脉压反应分别达到53% （95% CI, 38%-68%）和22% (95% CI, 12%-34%) （p = 0.001）。在研究药物开始时需要肾脏替代治疗的急性肾损伤患者中，与安慰剂组相比，血管紧张素II组的28天生存率和平均动脉压反应更高，肾脏替代治疗的释放率更高。这些发现表明，需要肾脏替代治疗的血管扩张性休克和急性肾损伤患者可能优先受益于血管紧张素II。
Supplemental Digital Content is available in the text. Acute 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. Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial. ICUs. Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively). IV angiotensin II or placebo. Primary 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. In 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.