Septic acute kidney injury and the optimal timing for initiation of acute blood purification

Abstract

Septic acute kidney injury (AKI) is an organ injury triggered by an “infectious” invasion and it usually occurs as part of the spectrum of multiple organ injuries, rather than as an injury to the kidney alone, with the involvement of serious clinical conditions such as higher mediator levels. In the event of kidney function loss, acute blood purification is initiated for renal support. Although a certain consensus has been obtained on the criteria for using blood purification including therapy durations (continuous or intermittent) and the dialysate/filtration flow rate, the optimal timing for initiation of blood purification has yet to be clarified in many guidelines due to lack of evidence. Furthermore, these criteria have been the focus of various ongoing studies. This issue is particularly complicated in Japan, where blood purification using cytokine-adsorbing hemofilter is actively employed to achieve removal of inflammatory mediators. To establish a standard for the timing of blood purification initiation, efforts must be made to further clarify the roles of blood purification in septic AKI.