1. 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

2. Is AKI relevant?

3. Is AKI relevant?

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

8. Sepsis and non-sepsis ICU patients
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

9. Intensive Care Over Nations
Audit 2012
Adult patients
ICU-LOS <24 h for routine postoperative surveillance: excluded
10 day follow-up period
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

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

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

12. Evolution of acute kidney injury

13. Evolution of acute kidney injury

14. Evolution of acute kidney injury

15. Evolution of acute kidney injury

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

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

18. Renal Replacement Therapy

19. Renal Replacement Therapy

20. Hospital mortality

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

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

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

24. Hospital mortality
Similar associations in no-sepsis patients

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

29. 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
Role of biomarkers?

30. Many issues are unknown in this specific group of vulnerable patients at this moment
Do we need to study this?