Predictors of Renal Replacement Therapy Requirement in Acute Kidney Injury Due to Urinary Sepsis: A Single-Center Retrospective Study.

Background: Urosepsis is defined as sepsis caused by an infection of the urogenital tract and is a systemic response to infection. Urosepsis is commonly treated in the intensive care unit (ICU) because of its acute and potentially lethal nature. Acute kidney injury (AKI) is a common complication of septic shock in ICU patients. This study predicted cases in which patients required renal replacement therapy (RRT) during the early stages of hospitalization. We also examined the relationship between the clinical information obtained at admission and the subsequent need for RRT.

Methods: This single-center, retrospective, observational study included 114 patients with sepsis caused by tract infections. We examined the multiple factors associated with AKI using clinical and social information. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines, with severe AKI defined as AKI requiring RRT. Logistic regression analyses were performed to identify the significant factors associated with severe AKI based on the information obtained at the time of admission.

Results: Severe AKI occurred in 12 patients. Multivariate analysis revealed that two factors were significantly associated with severe AKI: a high leukocyte count in the peripheral blood (> 22,100/μL) at admission (odds ratio: 21.972, 95% CI: 1.798-268.481) and the administration of vasopressors (odds ratio: 13.327, 95% CI: 1.009-176.091).

Conclusion: Physicians should be vigilant of the potential development of severe AKI in cases of urosepsis, particularly when patients require vasopressor and present with extremely high peripheral blood leukocyte counts at admission.