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Crit Care Med. 2018 Jun;46(6):949-957. doi: 10.1097/CCM.0000000000003092.

Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II.

Collaborators (472)

Szerlip H, Foreman M, Garrett J, Rabeler B, Mora A Jr, Friedman B, Shaver J, Busse LW, Altaweel L, Vourlekis J, Djurkovic S, Anderson S, Tanveer S, Ramesh S, Wang J, King C, Brannan T, Zhen S, Smith K, Southard C, Wunderink RG, Landmeier M, Raj R, Shah R, Russell S, Weiss C, Tumlin J, Galphin C, Poole C, Shome S, Gunter J Jr, Murugan R, Huang D, Gunn S, Kim H, Elmer J, Molyneaux B, Neal M, Puttarajappa C, Callaway C, Al-Khafaji A, Bihorac A, Smith W, Janelle G, White P, Wang X, Del Rio JM, Iboaya E, Al-Hegelan M, Jimenez A, Chung K, Pamplin J, Cancio L, Driscoll I, Graybill J, McCann E, Sams V, Rizzo J, Rowan M, Ainsworth C, Kashani K, Smischney N, Iyer V, Chock S, Kabler H, Stucke S, Campos K, Pratt B, Shin E, Johnson M, Richardson C, Fisher C, MacIntyre A, Kim K, Feinstein D, McQuaid D, Ramaswamy M, Hoffman P, Desai R, Rivet C, Yacoub W, Khanna A, Sessler D, Perez Protto S, Sreedharan R, Liu J, Ayad S, Elo B, Udeh C, Hite RD, Duggal A, Hanane T, Chodavarapu P, Saha P, Schacham Y, Oguz Yilmaz H, Ham K, Dries D, Emiru T, Brogan M, Bennett B, Nguyen HB, Bland D, Giri P, Dinh V, Maken K, Tan L, Albertson T, Morrissey B, Black H, Sandrock C, Sebat C, Hou P, Frendl G, Guanaga D, Long M, Loughlin J, Gemunden S, Seethla R, Pentakota S, Askari R, Aisiku I, Boldt D, Singh S, Gudzenko V, Meltzer J, Chang S, Saggar R, Barjaktarevic I, Edwards W, Rolston D, Gong M, Hsieh SJ, Hope A, Soto G, Gershengorn H, Qadir N, Kordesch K, Bhatt M, Gary B, Chen T, Lee L, Wu CP, Ataucuri-Vargas J, Dahn C, Koura F, Akers L, Raichel M, Kethireddy S, Layon A, Blyler K, Weller R, Bagnata L, Herring M, Snyder T, Mitchell M, Penupolu S, Nealy Z, Perez J, Snell K, Merkel M, Treggiari M, Krell K, Thornley A, Miller J, Naum C, Kapoor R, Pohlman T, Duncan M, Adams H, Turk E, Oakes T, Hashmi K, Broach D, Thorp AM, Strickland T, Logan B, McNamee R, Nash J, Isaacs T, Lynn C, Ferrada P, Anand R, DeAntonio J, Leichtle S, Strumwasser A, Grabo D, Clark D, Biswas S, Pechulis R, Schwed-Lustgarten D, Eichelberger T, Knittle D, Strow J, Baga L, Loburak S, Novak J, Watson D, Marsh H, Hoffman-Huffaker S, Rovella J, Laskosky J, Khanna A, Sessler D, Perez-Protto S, Sreedharan R, Liu J, Ayad S, Elo B, Udeh C, Hite D, Duggal A, Hanane T, Chodavrapu P, Saha P, Schacham Y, Oguz Yilmaz H, Galphin C, Harper M, Tumlin J, Rice D, McCurdy M, Haase D, Zimmermann DM, Prekker M, Leatherman J, Ambur S, Huelster J, Jacoby K, Dodd K, Soto E, Strumwasser A, Grabo D, Clark D, Biswas S, Mackey C, Baird I, Cordasco E Jr, Zeno B, Bhullar S, Lee H, Rudinsky D, Swiatek K, Kandiah P, Subramaniam R, Pimentel C, Sadan O, Killian A, Bellomo R, Walsham J, Krishnan A, Dobb G, Ray S, Chapman A, McNamara R, Bennett A, Bowles T, Webb S, Bihari S, Bersten A, Richards B, Winearls J, Pearson D, Deane A, Chapman M, Reddi B, Wong H, Yeo N, Abdelhamid Y, Davies A, Tiruvoipati R, Litton E, Regli A, Allen C, De Keulenaer B, Cooper D, Van Haren F, Chan S, Singh M, Rai S, Diel N, Finfer S, Janin P, Delaney A, Stedman W, Flower O, Cohen J, Lipman J, Venkatesh B, Reid A, Gill D, Cohen J, Seppelt I, MacIsaac C, Rechnitzer T, Anstey J, Sriram S, Panwar R, Bierl C, Martinez E, Havill K, O'Connor R, Jamieson P, Young P, Poynter C, Hicks P, Sturland S, Barry B, Dinsdale R, Psirides A, Ure R, McArthur C, Bishop G, Hourigan C, Galler L, Smith R, Streat S, Gardiner P, Benson-Cooper K, Van der Poll A, Pullinen KJ, Zygun D, Gibney RTN, Karvellas C, Meier M, Boyd J, Ayas N, Peets A, Sirounis D, Walley K, English SW, Pagliarello G, Seely A, McIntyre L, Jones G, Muscedere J, Boyd JG, Bridge S, D'Arsigny C, Drover J, Erb J, Galvin I, Heffernan P, Howes D, Ilan R, Maslove D, Messenger D, Parker C, Sibley S, Doig C, Au S, Chrusch C, Kortbeek J, McBeth P, Posadas-Calleja J, Des Ordons A, Yipp B, Wood G, Ovakim D, English SW, Pagliarello G, Seely A, McIntyre L, Jones G, Hästbacka J, Pettilä V, Wilkman E, Vaara S, Bäcklund M, Skrifvars M, Valkonen M, Okkonen M, Jakkula P, Efendijev I, Karlsson S, Kuitunen A, Jalkanen V, Vahtera A, Långsjö J, Hoppu S, Valtonen M, Heiro J, Arola O, Inkinen O, Järvisalo M, Takala R, Kaskinoro K, Grönlund J, Prowle J, Kirwan C, Zolfaghari P, Pearse R, Leitch A, Hewson R, O'Dwyer M, O'Connor M, Haines R, Snelson C, Whitehouse T, Pemberton P, Wilkinson J, Outram M, Malanjum L, Webster R, Popple DW, Leng C, Hardwick J, Gratrix A, Pettit J, Balakumar E, Smith I, Ventour D, Ostermann M, Wyncoll D, Shankar-Hari M, Camporota L, McKenzie C, Perkins G, Yeung J, Turner J, Crooks N, Dennis A, Welters I, Wenstone R, Walker J, Cloherty L, Bewley J, Dellamonica J, Nseir S, Ledoux G, Lawson R, Six S, Onimus T, Préau S, Jourdain M, Gury-Duburcq E, Robriquet L, Rouzé A, Masse J, El Kalioubie A, Voisin B, Jaillette E, Parmentier E, Moreau AS, Poissy J, Thibault D, Granier M, Girardie P, Satre-Buisson L, Van Aken H, Zarbock A, Meersch M, Creteur J, Brimioulle S, Grimaldi D, Chawla LS, Bagshaw S, Fink MP, Goldstein SL, Shaw A, Russell J, Tidmarsh G, Bellomo R, Khanna A, Busse LW, Ostermann M, Chawla LS, Thompson BT, English SW, Young P, Deane AM, Singer J.

Author information

1
University of Tennessee College of Medicine, Chattanooga TN.
2
Department of Critical Care Medicine, and Clinical and Translational Science, Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA.
3
Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Grattan St, Parkville, Victoria, VIC, Australia.
4
King's College London, Guy's & St Thomas' Hospital, London, UK.
5
Emory University, Department of Medicine, Atlanta, GA.
6
University of Minnesota Medical School.
7
Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
8
Baylor University Medical Center, Dallas, TX.
9
Adult Critical Care Unit, Department of Renal and Transplant Medicine, The Royal London Hospital, London, UK.
10
Division of Nephrology, Hypertension, & Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL.
11
University of Texas Health Science Center at Houston, Houston, TX.
12
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
13
Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey & Critical Care Unit, Royal Surrey County Hospital, Guildford, UK.
14
La Jolla Pharmaceutical Company.
15
The University of Melbourne, Melbourne, VIC, Australia Austin Hospital, Heidelberg, VIC, Australia Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Abstract

OBJECTIVE:

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.

DESIGN:

Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial.

SETTING:

ICUs.

PATIENTS:

Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively).

INTERVENTIONS:

IV angiotensin II or placebo.

MEASUREMENTS AND MAIN RESULTS:

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.

CONCLUSIONS:

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.

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