Skip to main content
SpringerLink
Log in

Aggressive Resuscitation Is Associated with the Development of Acute Kidney Injury in Acute Pancreatitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Introduction

The association between early resuscitation volume and clinical outcomes remains controversial in acute pancreatitis. In the present study, we aimed to identify the association between resuscitation volume and the development of acute kidney injury (AKI) and other clinical outcome metrics.

Methods

Patients admitted to our center with moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) from January 2009 to December 2013 were reviewed retrospectively. Patients were stratified into two groups on the basis of the volume of fluid infused during the first 24 h. The primary clinical endpoint was incidence of AKI. Moreover, AKI lasting time, utilization of continuous renal replacement therapy and lasting time, creatinine increase, and other clinical metrics were also compared. The potential risk factors of new-onset AKI were also analyzed.

Results

A total of 179 patients were included, and aggressive fluid resuscitation (≥ 4 l) was associated with increased incidence of AKI compared with nonaggressive group (53.12% vs. 25.64%, p = 0.008), longer AKI lasting time (p = 0.038), and increased creatinine increase (p < 0.001) during hospitalization. Moreover, utilization of continuous renal replacement therapy was more frequent in aggressive group (40.63% vs. 24.36%, p = 0.108), and the lasting time of continuous renal replacement therapy was also longer (p = 0.181), though both not statistically different. Moreover, in multivariate analysis, aggressive resuscitation [OR 4.36 (1.52–13.62); p = 0.001] and chloride exposure [OR 2.53 (1.26–5.21); p = 0.012] in the first 24 h were risk factors of new-onset AKI.

Conclusion

In patients with MSAP and SAP, aggressive fluid resuscitation was associated with increased incidence and longer duration of AKI. Moreover, aggressive resuscitation and chloride exposure in the first 24 h were risk factors of new-onset AKI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wig JD, Bharathy KG, Kochhar R, et al. Correlates of organ failure in severe acute pancreatitis. JOP. 2009;10:271–275.

    PubMed  Google Scholar 

  2. Vege SS, Gardner TB, Chari ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include “moderately severe acute pancreatitis”. Am J Gastroenterol. 2009;104:710–715.

    Article  Google Scholar 

  3. Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–1415; 1416.

  4. Mao EQ, Fei J, Peng YB, et al. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J (Engl). 2010;123:1639–1644.

    CAS  Google Scholar 

  5. Monnet X, Julien F, Ait-Hamou N, et al. Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders. Crit Care Med. 2013;41:1412–1420.

    Article  CAS  Google Scholar 

  6. Warndorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011;9:705–709.

    Article  Google Scholar 

  7. Wall I, Badalov N, Baradarian R, et al. Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas. 2011;40:547–550.

    Article  Google Scholar 

  8. Kuwabara K, Matsuda S, Fushimi K, et al. Early crystalloid fluid volume management in acute pancreatitis: association with mortality and organ failure. Pancreatology. 2011;11:351–361.

    Article  Google Scholar 

  9. de-Madaria E, Soler-Sala G, Sanchez-Paya J, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011;106(10):1843–1850.

    Article  Google Scholar 

  10. Mao EQ, Tang YQ, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl). 2009;122:169–173.

    Google Scholar 

  11. Mao EQ, Tang YQ, Li L, et al. Strategy of controlling fluid resuscitation for severe acute pancreatitis in acute phase. Zhonghua Wai Ke Za Zhi. 2007;45:1331–1334.

    PubMed  Google Scholar 

  12. Eckerwall G, Olin H, Andersson B, et al. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better? Clin Nutr. 2006;25:497–504.

    Article  Google Scholar 

  13. Gardner TB, Vege SS, Chari ST, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology. 2009;9:770–776.

    Article  Google Scholar 

  14. Brown A, Baillargeon JD, Hughes MD, et al. Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology. 2002;2:104–107.

    Article  CAS  Google Scholar 

  15. Dellinger EP, Forsmark CE, Layer P, et al. Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg. 2012;256:875–880.

    Article  Google Scholar 

  16. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

    Article  Google Scholar 

  17. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–710.

    Article  CAS  Google Scholar 

  18. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–1652.

    Article  CAS  Google Scholar 

  19. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.

    Article  Google Scholar 

  20. Devlin JJ, DeVito SS, Littlejohn LF, et al. Terlipressin with limited fluid resuscitation in a swine model of hemorrhage. J Emerg Med. 2013;45:78–85.

    Article  Google Scholar 

  21. Li Y, Guo M, Shen J, et al. Limited fluid resuscitation attenuates lung and intestine injury caused by hemorrhagic shock in rats. J Invest Surg. 2014;27:81–87.

    Article  Google Scholar 

  22. Yashiro M, Hamada Y, Matsushima H, et al. Estimation of filtration coefficients and circulating plasma volume by continuously monitoring hematocrit during hemodialysis. Blood Purif. 2002;20:569–576.

    Article  CAS  Google Scholar 

  23. Tsai YC, Tsai JC, Chen SC, et al. Association of fluid overload with kidney disease progression in advanced CKD: a prospective cohort study. Am J Kidney Dis. 2014;63(1):68–75.

    Article  Google Scholar 

  24. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33:951–962.

    Article  Google Scholar 

  25. Dalfino L, Tullo L, Donadio I, et al. Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med. 2008;34:707–713.

    Article  Google Scholar 

  26. Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–1572.

    Article  CAS  Google Scholar 

  27. Mehta RL, Pascual MT, Soroko S, et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–2553.

    Article  CAS  Google Scholar 

  28. Suetrong B, Pisitsak C, Boyd JH, et al. Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients. Crit Care (Lond, Engl). 2016;20:315.

    Article  Google Scholar 

  29. Sadan O, Singbartl K, Kandiah PA, et al. Hyperchloremia Is associated with acute kidney injury in patients with subarachnoid hemorrhage. Crit Care Med. 2017;45:1382–1388.

    Article  CAS  Google Scholar 

  30. Riha HM, Erdman MJ, Vandigo JE, et al. Impact of moderate hyperchloremia on clinical outcomes in intracerebral hemorrhage patients treated with continuous infusion hypertonic saline: a pilot study. Crit Care Med. 2017;45:e947–e953.

    Article  CAS  Google Scholar 

  31. Patel N, Baker SM, Walters RW, et al. Serum hyperchloremia as a risk factor for acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. In Proceedings of Baylor University Medical Center 2016;29(1):7–11.

  32. Pezzilli R, Zerbi A, Campra D, et al. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis. 2015;47:532–543.

    Article  Google Scholar 

  33. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1–15.

  34. Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepato Biliary Pancreat Sci. 2015;22:405–432.

    Article  Google Scholar 

  35. Shaw AD, Raghunathan K, Peyerl FW, et al. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med. 2014;40:1897–1905.

    Article  CAS  Google Scholar 

  36. Khan Z, Vlodov J, Horovitz J, et al. Urinary trypsinogen activation peptide is more accurate than hematocrit in determining severity in patients with acute pancreatitis: a prospective study. Am J Gastroenterol. 2002;97:1973–1977.

    Article  CAS  Google Scholar 

Download references

Funding

This study was supported by the National Science Foundation of China (81770641).

Author information

Author notes

  1. Bo Ye, Wenjian Mao, and Yuhui Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China

    Bo Ye, Wenjian Mao, Yuhui Chen, Zhihui Tong, Gang Li, Jing Zhou, Lu Ke & Weiqin Li

Authors
  1. Bo Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenjian Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuhui Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhihui Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jing Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lu Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Weiqin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. WL and LK designed the work, Dr. ZT, GL, and JZ collected the data, Dr. BY wrote the paper, and Dr. WM and Dr. YC analyzed the data. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Lu Ke or Weiqin Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ye, B., Mao, W., Chen, Y. et al. Aggressive Resuscitation Is Associated with the Development of Acute Kidney Injury in Acute Pancreatitis. Dig Dis Sci 64, 544–552 (2019). https://doi.org/10.1007/s10620-018-5328-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5328-5

Keywords

Search

Navigation