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Acute kidney damage and extracorporeal (organ replacement) therapy

AG Nusshag

Acute kidney injury (AKI) is a clinical syndrome defined by a spontaneous decline in renal function. The causes are very complex and often multifactorial in nature.
It affects around 8-15% of patients admitted to hospital, with an estimated annual incidence of up to 100 million cases worldwide. In Germany, too, the diagnosis of AKI in hospitalized patients is increasing by an annual average of 11%.
Early detection and adequate treatment is of enormous relevance, as even moderate deterioration in kidney function / kidney damage is associated with increased hospital mortality.

However, not only the short-term, but also the longer-term consequences of AKI-associated diseases in the form of increased morbidity and mortality as well as the transition to chronic or even terminal renal failure after surviving AKI are alarming. Patients in intensive care units (ICUs) represent a particular risk group. Up to 57% of intensive care patients develop AKI, whereby the incidence of AKI varies greatly depending on the respective specialist discipline and hospital structure. Approximately one third of all AKIs can be attributed to a surgical context. The incidence of AKI is approx. 32% after cardiac surgery, 20-25% after abdominal surgery and orthopaedic surgery and around 12% after neurosurgery.

In addition to major surgical interventions, shock states, drug-induced damage and urinary outflow obstructions are both risk factors and causes of AKI in descending order of frequency. However, established and novel oncological therapy regimes also lead to a further increase in the number of AKIs due to their nephrotoxic side effect profile. In 50% of cases, however, sepsis (blood poisoning) dominates as the etiology of AKI in the ICU. At 25-60%, AKI-associated hospital mortality in ICU patients has remained high for years, especially in patients with AKI requiring RRT.

Depending on the specialist environment and cause of AKI, 6-20% of patients develop the need for RRT. The frequency of RRT applications also increases by 10% annually. 12-25% of these patients remain dependent on a renal replacement procedure in the long term.

In summary, AKI is therefore a disease entity with far-reaching consequences for the individual patient and presents doctors and the healthcare system with enormous challenges. Our primary goal is therefore to provide the best possible care for these patients. To this end, we are working on innovative, new diagnostic and therapeutic approaches to significantly improve AKI management in the future.

Above all, our aim is to gain a better understanding of the pathogenesis of AKI, as there is still a lack of targeted therapeutic options. In close cooperation with colleagues from the Department of Anaesthesiology, Surgery and Internal Medicine at Heidelberg University Hospital as well as industrial partners, we are therefore researching the immunological and metabolic disease mechanisms of AKI as well as the development and validation of biomarkers for optimized diagnostics, therapy control and kidney function determination.

Another focus of our team is the research, establishment and further development of extracorporeal organ replacement procedures in critically ill patients. In addition to optimizing the use of RRT, we are also concentrating on other extracorporeal therapies such as liver support procedures, procedures for removing bacterial toxins and inflammatory substances and plasma exchange procedures for inflammatory disease states.

In this context, we are currently investigating the therapeutic efficacy of plasma exchange in COVID-19 patients requiring intensive care with SARS-CoV-2-associated hyperinflammation syndrome. Initial data from our working group suggest that plasma exchange improves survival in these patients by mitigating the complex inflammatory disease processes.

 

Project management

Dr. med. Christian Nusshag

+49 6221 9112 0

Partner / Cooperation

Department of Anesthesiology, Heidelberg University Hospital

Department of Gastroenterology, Infectious Diseases and Poisoning, Heidelberg University Hospital

Department of Cardiac Surgery, Heidelberg University Hospital

RUSH University Chicago, Department of Internal Medicine (Prof. Dr. Jochen Reiser)

Essen University Hospital, Department of Anesthesiology (Prof. Dr. Thorsten Brenner)

Klinikum Stuttgart, Clinic for Kidney, Hypertension and Autoimmune Diseases (Prof. Dr. Vedat Schwenger)

COS Heidelberg (Dr. Gernot Poschet)