Nicole Stenzel, PharmD, BCPS
Critical Care Pharmacist
Sanford Medical Center Fargo, United States
Disclosure information not submitted.
Megan Moore, BCCCP, BCPS, PharmD
Critical Care Pharmacist
Sanford Medical Center Fargo, United States
Disclosure information not submitted.
Title: Vasopressin use in those with non-native kidney does not decrease need for renal replacement therapy
Introduction: In previous studies, the use of vasopressin compared to norepinephrine in septic shock did not improve the number of kidney failure-free days but did decrease the amount of renal replacement therapy required. The purpose of this study is to investigate the potential benefits of vasopressin in preventing the need for renal replacement in patients who have received a kidney transplant.
Methods: This was a retrospective matched cohort study. comparing patients. Patients from four regional medical centers in the United States were reviewed between January 2011 to December 2018. Inclusion criteria were: ≥ 18 years of age, coding for a non-native kidney, and shock of any etiology. The only exclusion was hemodialysis prior to vasopressor initiation. The primary outcome was need for renal replacement therapy. Secondary outcomes included kidney failure free days at 30 days, time to renal replacement therapy, ICU length of stay, maximum dose of norepinephrine equivalent during shock treatment, and mean vasopressor duration in days. Each vasopressin patient was matched in a 3:1 ratio through hierarchical cluster analysis with patients resuscitated with vasopressors not including vasopressin.
Results: A total of 179 patients were eligible for inclusion into the study cohort. After applying the pre-specified exclusion criteria, 18 vasopressin patients were matched to 54 non-vasopressin patients. The primary endpoint was not significantly different between the two groups (2 (11.11%) v. 9 (16.67%); P = .56). Maximum dose of norepinephrine equivalent was significantly higher in the vasopressin group (0.3 (0.108 – 1.81) v. 0.12 (0.035 – 0.86); P = .004). Vasopressor duration was also significantly higher in the vasopressin group (2.5 (1 – 13.2) v. 1 (1 – 5.5); P = .049).
Conclusions: Vasopressin did not decrease the need for renal replacement therapy. Source of shock and degree of shock severity were unbalanced baseline differences that may have directly impacted the outcomes of interest. In summary, this small retrospective study prompts further investigation with a larger cohort to assess impact of vasopressors post-kidney transplant on renal associated outcomes.