4.5 Article

Extracorporeal blood purification therapies for sepsis-associated acute kidney injury in critically ill patients: expert opinion from the SIAARTI-SIN joint commission

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JOURNAL OF NEPHROLOGY
卷 -, 期 -, 页码 -

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SPRINGER HEIDELBERG
DOI: 10.1007/s40620-023-01637-5

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Extracorporeal blood purification therapies; Sepsis-associated AKI; Cytokine removal; Endotoxin removal; Italian Society of Anaesthesia Analgesia Reanimation and Intensive Care; Italian Society of Nephrology

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Sepsis-associated acute kidney injury (AKI) is a life-threatening condition with high morbidity and mortality in critically ill patients. Despite the development of various extracorporeal blood purification therapies for sepsis and sepsis-associated AKI, there are still unresolved questions regarding the indications and timing of renal replacement therapy, optimal dialysis dose, and rationale for using these therapies in septic patients without AKI. There is also growing interest in novel blood purification therapies using adsorption devices for specific mediators clearance and antibiotic removal. A joint commission of the Italian Society of Anesthesiology and Critical Care and the Italian Society of Nephrology addressed these issues, proposed recommendations, and developed a framework for future research in this field.
Sepsis-Associated Acute Kidney Injury is a life-threatening condition leading to high morbidity and mortality in critically ill patients admitted to the intensive care unit. Over the past decades, several extracorporeal blood purification therapies have been developed for both sepsis and sepsis-associated acute kidney injury management. Despite the widespread use of extracorporeal blood purification therapies in clinical practice, it is still unclear when to start this kind of treatment and how to define its efficacy. Indeed, several questions on sepsis-associated acute kidney injury and extracorporeal blood purification therapy still remain unresolved, including the indications and timing of renal replacement therapy in patients with septic vs. non-septic acute kidney injury, the optimal dialysis dose for renal replacement therapy modalities in sepsis-associated acute kidney injury patients, and the rationale for using extracorporeal blood purification therapies in septic patients without acute kidney injury. Moreover, the development of novel extracorporeal blood purification therapies, including those based on the use of adsorption devices, raised the attention of the scientific community both on the clearance of specific mediators released by microorganisms and by injured cells and potentially involved in the pathogenic mechanisms of organ dysfunction including sepsis-associated acute kidney injury, and on antibiotic removal. Based on these considerations, the joint commission of the Italian Society of Anesthesiology and Critical Care ( SIAARTI) and the Italian Society of Nephrology (SIN) herein addressed some of these issues, proposed some recommendations for clinical practice and developed a common framework for future clinical research in this field. [GRAPHICS]

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