Acute Kidney Injury in critically ill patients: a seemingly simple syndrome

Wiersema, R., 2020, [Groningen]: University of Groningen. 204 p.

Research output: ThesisThesis fully internal (DIV)

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  • Title and contents

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  • Chapter 1

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Critically ill patients are at risk of chronic organ failure. The kidneys are vulnerable organs that endure severe illnesses and treatments. Both may contribute to a sudden decrease in renal function; i.e. Acute Kidney Injury (AKI). AKI is one of the most frequently developing complications during ICU stay and reported incidences vary from 20% to 70% depending on used criteria. The exact pathophysiological mechanisms are largely unclear and there is no other treatment besides prevention and support.
Risk factors for AKI include age, comorbidities, severity of illness, and the presence of (septic) shock. Decreased renal perfusion may induce local changes in the kidney and this was assumed to be an consequence of shock. However, evidence is accumulating that fluid overload or increased venous pressure (also called venous congestion, stasis of bloodflow in the venous system) may also aggravate AKI. In this thesis, we attempted to visualise and measure venous congestion using regularly obtained variables from clinical examination, biochemical analysis and ultrasonography. The associations between various measures of venous congestion and AKI were investigated, showing that indeed venous congestion may play a role. The most important result within this thesis was that variations in methodology to explicate these two complex syndromes results in significant differences in outcomes, hampering comparisons of existing research. Moreover, the observational nature of the data in this thesis provides hypotheses, but the results of randomised controlled trials need to be awaited to provide causal evidence for recommendations and guidelines for fluid management and AKI in clinical practice.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Award date5-Oct-2020
Place of Publication[Groningen]
Publication statusPublished - 2020

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