Journal Article

Acute kidney injury in neurocritical care

Tolwani, Ashita J., Ramírez-Guerrero, Gonzalo, Husain-Syed, Faeq, Rosner, Mitchell H., Takeuchi, Tomonori, Neyra, Javier A., Ronco, Claudio

2023

Overview

Approximately 20% of patients with acute brain injury (ABI) also experience acute kidney injury (AKI), which worsens their outcomes. The metabolic and inflammatory changes associated with AKI likely contribute to prolonged brain injury and edema. As a result, recognizing its presence is important for effectively managing ABI and its sequelae. This review discusses the occurrence and effects of AKI in critically ill adults with neurological conditions, outlines potential mechanisms connecting AKI and ABI progression, and highlights AKI management principles. Tailored approaches include optimizing blood pressure, managing intracranial pressure, adjusting medication dosages, and assessing the type of administered fluids. Preventive measures include avoiding nephrotoxic drugs, improving hemodynamic and fluid balance, and addressing coexisting AKI syndromes. ABI patients undergoing renal replacement therapy (RRT) are more susceptible to neurological complications. RRT can negatively impact cerebral blood flow, intracranial pressure, and brain tissue oxygenation, with effects tied to specific RRT methods. Continuous RRT is favored for better hemodynamic stability and lower risk of dialysis disequilibrium syndrome. Potential RRT modifications for ABI patients include adjusted dialysate and blood flow rates, osmotherapy, and alternate anticoagulation methods. Future research should explore whether these strategies enhance outcomes and if using novel AKI biomarkers can mitigate AKI-related complications in ABI patients. Graphical abstract

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute Kidney Injury - etiology / Acute Kidney Injury - therapy / Acute renal failure / Adult / Blood Pressure / Brain / Brain Injuries - complications / Brain Injuries - therapy / Care and treatment / Cerebrovascular disease / Complications and side effects / Continuous Renal Replacement Therapy / Creatinine / Critical care / Critical Care Medicine / Cytokines / Development and progression / Diabetes / Dialysis disequilibrium syndrome / Edema / Emergency Medicine / Epidemiology / Hemodynamics / Humans / Injuries / Intensive / Intensive care / Intracerebral hemorrhage / Kidney diseases / Medicine / Medicine & Public Health / Metabolism / Mortality / Nervous system / Nosocomial infections / Renal replacement therapy / Review / Rhabdomyolysis / Risk factors / Sepsis / Stroke / Stroke (Disease) / Subarachnoid hemorrhage / Toxicity / Traumatic brain injury