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AKI in critically ill cancer patients: Do we need more studies?

AKI in critically ill cancer patients: Do we need more studies?. Peter Pickkers Department of Intensive Care Medicine Radboud university medical centre , Nijmegen. Paris, March 28th 2017. Is AKI relevant?. Is AKI relevant?. Patient numbers who were identified at each level, and

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AKI in critically ill cancer patients: Do we need more studies?

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  1. AKI in critically ill cancer patients: Do we need more studies? Peter Pickkers Department of Intensive Care Medicine Radboud universitymedicalcentre, Nijmegen Paris, March 28th 2017

  2. Is AKI relevant?

  3. Is AKI relevant?

  4. Patient numbers who were identified at each level, and the percentage of the total number of patients Sepsis and non-sepsis ICU patients

  5. Patient numbers who were identified at each level, and the percentage of the total number of patients 5.5% 8.8% 11.4% 26.3% Sepsis and non-sepsis ICU patients

  6. Intensive Care Over Nations • Audit 2012 • Adult patients • ICU-LOS <24 h for routine postoperative surveillance: excluded • 10 day follow-up period • 10 069 patients were included in the Intensive Care Over Nations (ICON) audit • 9 579 patients were eligible for the analyses • 30% sepsis, 70% non-sepsis • Europe (54%), Asia (19%), and the Americas (17%) • P.I.: Prof JL Vincent

  7. Evolution of acute kidney injury Failure Injury Risk No-AKI

  8. Evolution of acute kidney injury Failure Injury Risk No-AKI

  9. Evolution of acute kidney injury

  10. Evolution of acute kidney injury

  11. Evolution of acute kidney injury

  12. Evolution of acute kidney injury

  13. Overall mortality Log-rank statistics, p<0.001 No AKI No AKI Risk Injury Risk CRF Injury Failure CRF Failure 9579 patients, CRF: 912 patients

  14. Overall mortality Log-rank statistics, p<0.001 No AKI No AKI Risk Injury Risk CRF Injury Failure CRF Failure 2012 2000 9579 patients, CRF 912 patients 5383 patients

  15. RenalReplacementTherapy

  16. RenalReplacementTherapy

  17. Hospital mortality

  18. Hospital mortality • Recovery from AKI-F: 15-20% lower mortality

  19. Hospital mortality • Recovery from AKI-F: 15-20% lower mortality

  20. Hospital mortality • However, still twice as high as patients with No-AKI at all • Recovery from AKI-F: 15-20% lower mortality

  21. Hospital mortality • Similar associations in no-sepsis patients

  22. AKI in critically ill cancer patients • AKI occurs in 70% of critically ill cancer patients • Early ICU admission: better survival

  23. Remaining questions • Difference in AKI kinetics per cause of AKI (cancer patients different from the ‘regular’ critically ill patient) • Effect of transition to other AKI severity category on outcome • Outcome AKI vs patients admitted with Chronic Renal Failure • Changes in ICU admission policy 2006-2017 • Role of biomarkers?

  24. Do we need to study this? Many issues are unknownin thisspecificgroup of vulnerablepatientsat this moment

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