Speakers to stress early action on AKIs in ICU to prevent multiorgan failure

Acute kidney injury (AKI) is one of the most common organ failures in the course of critical illness, regardless of the cause of ICU admission. “Even transient episodes of kidney injury followed by full recovery in ICU appear to increase the long-term risk of end-stage renal disease, cardiovascular morbidity, and poor quality of life in the survivors,” said Aanchal Kapoor, MD, FCCP, Founder and Director of the Medical Intensive Liver Unit at Cleveland Clinic.

Dr. Kapoor will chair the CHEST 2025 session Critical Illness AKI and Organ-Crosstalk on Monday, October 20, at 9:15 am in McCormick Place, Lakeside Center, Room 351. Four speakers will explore the interplay of various organs during critical illness and discuss risk classification and management of AKIs in the ICU. The physiological interactions between the kidneys and other organs during critical illness can contribute to increased morbidity and mortality during the ICU stay and long after discharge, but early action to interrupt the downward spiral of multiorgan failure can make a significant difference in clinical outcomes, Dr. Kapoor said.

“There are physiological interactions between [the] kidneys and other organs, including [the] heart, lung, liver, brain, gut, vascular, and immune systems,” she said. “And the mechanisms, including uremia, inflammatory and immune response, oxidative stress, dynamic hemodynamic status, fluid homeostasis, renin-angiotensin-aldosterone system activation, are responsible for crosstalk between kidneys and other organs.”

AKI is not the only trigger for multiorgan failure during critical illness. Almost any severe illness or injury to other organs can spark a downward physiological cascade and result in kidney injury.

In patients with pneumonia who are mechanically ventilated, for example, mechanisms such as increased intrathoracic pressure, high positive end-expiratory pressure, inflammatory cytokines, activation of the renin-angiotensin system, and increased abdominal pressure can result in in AKI and multiorgan failure.

Multiple machine learning models are being created to predict the development of AKI and multiorgan failure in patients who are critically ill. Recognizing phenotypes could help risk stratify patients to prompt earlier treatment.

“Early use of medications, adjusting [the] dose of certain medications, avoidance of nephrotoxic medications, and assessing fluid status during critical illness in phenotypes prone to developing AKI can prevent incoming kidney injury,” Dr. Kapoor said. “Acting early with, for example, diuretics and fluid resuscitation strategies, optimizing mechanical ventilation, and early use of terlipressin in patients with hepatorenal syndrome, is a key message.”

“Organ crosstalk is not a one-way street; it is two-way interaction between multiple organs,” she added. “The goal of this session is to understand the pathophysiological mechanisms and act early to prevent multiorgan dysfunction.”