Intravenous hydrocortisone may reduce risk of kidney failure in patients with sepsis

1. Intravenous hydrocortisone treatment was associated with reduced odds of new kidney replacement in patients with septic shock.

Evidence Rating Level: 2 (Good)

The incidence of sepsis-associated acute kidney injury (SA-AKI) is increasing among patients admitted to the intensive care unit (ICU). SA-AKI is associated with an increased risk of mortality and kidney impairment among survivors. Although extensive research exists on the corticosteroid hydrocortisone as an adjunctive therapy in septic shock, research on its impact on SA-AKI and kidney replacement therapy (KPT) requirement is limited. This study thus examined the association between intravenous hydrocortisone and the incidence of subsequent KRT requirement. This cohort study was a post hoc analysis of the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) randomized clinical trial (RCT). This multicenter placebo-controlled RCT of hydrocortisone included patients from ICUs in Australia, the United Kingdom, New Zealand, Saudi Arabia, and Denmark recruited between 2013 and 2017. The post-hoc analysis included all patients enrolled in the ADRENAL study with septic shock who did not require KRT in the 24 hours prior to randomization and who did not have a prior longstanding dialysis requirement. The primary outcome was the incidence of new KRT requirement following randomization. Out of the 3,161 patients included (median [IQR] age = 65 [53-74] years, male [%] = 1,921 [61%]), 1,589 patients were randomized to receive hydrocortisone and 1,572 received the placebo. Patients in the hydrocortisone group had a reduced incidence of new KRT requirement compared with those in the placebo group (329 patients [21%] vs 372 patients [24%]; odds ratio [OR], 0.84 [95% CI, 0.70 to 0.99]; P = .04). Hydrocortisone treatment remained associated with reduced odds of new KRT requirement (OR, 0.79 [95% CI, 0.66 to 0.95]; P = .01), even after adjusting for factors associated with KRT requirement. Among patients who started KRT after randomization, hydrocortisone treatment was not associated with reduced days alive and free of KRT (mean difference, 1.28 [95% CI, −4.31 to 6.87] days; P = .65). Overall, this study found that use of adjunctive hydrocortisone was associated with reduced risk of new KRT requirement. Future studies are needed to confirm these findings.

Click to read the study in JAMA Network Open

Image: PD

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