An AKI project for critically ill cancer patients Peter Pickkers Department of Intensive Care Medicine Radboud university medical centre, Nijmegen Paris, March 28th 2017

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?

Evolution of acute kidney injury

Evolution of acute kidney injury

Evolution of acute kidney injury

Evolution of acute kidney injury

Hospital mortality

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

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

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

Baseline demographics Age Male sex Comorbidities Cause underlying immune suppression High BMI Diabetes Chronic liver disease Chronic heart disease Chronic kidney impairment Creatinine, baseline  

Aetiological risk factors Dehydration Hypotension or shock Cardiac Liver Acute kidney disease Urinary obstruction Infection, sepsis Systemic diseases Nephrotoxic agents

Other organ failures at acute kidney injury confirmation day Pulmonary Cardiovascular Neurological Hepatic Haematological None Number of organ failures: 0, 1, 2, 3

At acute kidney injury diagnosis sCr (μmol/L) BUN (mmol/L) Urine output past 24 h (mL) Criteria for acute kidney injury diagnosis sCr (alone) Oliguria (alone) sCr and urine output Stage at diagnosis (1, 2, 3) Biomarkers?

Multivariate analyses that determines renal and clinical outcome in these patients, including Age Hospital-acquired acute kidney injury Number of organ failures Sepsis Use of antibiotics Oliguria Chronic kidney disease Need for dialysis Limitations of treatment, including RRT