(80521) Deep Dive: Acute Kidney Injury and Organ Crosstalk During Critical Illness (This program is supported by an educational grant from Mallinckrodt Pharmaceuticals)

More than 50% of critically ill patients develop acute kidney injury (AKI). Mortality among patients with AKI and multiorgan failure in the ICU is reported to exceed 50%. Understanding physiologic interactions between the kidney and other organs, including heart and lung, is important to streamline management strategies for AKI. Approximately 2% to 30% of AKI survivors progress to end-stage renal disease (ESRD). Patients who recover renal function during their ICU stay have a significant risk of developing progressive renal dysfunction. Even transient episodes followed by full recovery appear to increase the long-term risk of ESRD, cardiovascular morbidity, and poor quality of life. Association between AKI and multiorgan dysfunction in the ICU might be responsible for the long-term sequelae. Multiple mechanisms including uremia, inflammatory and immune response, oxidative stress, dynamic hemodynamic status, fluid homeostasis, and renin-angiotensin-aldosterone system activation are responsible for organ crosstalk between kidneys, lung, liver, heart, brain, gut, and vascular system. Appropriate and timely diagnostic tools for these complex interactions and adjusting therapeutic inventions accordingly can improve outcomes. Appropriate pharmacologic interventions based on multiorgan interactions and attention to pharmacokinetics and pharmacodynamics can prevent further damage.