Critical Care: Miscellaneous Critical Care |

Role of Inhaled Nitric Oxide in Kidney Injury FREE TO VIEW

Katherine Chiapaikeo-Poco, DO; Killol Patel, MD; Harish Seethamraju, MD
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Newark Beth Israel, Edison, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):326A. doi:10.1016/j.chest.2016.08.339
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SESSION TITLE: Miscellaneous Critical Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The use of inhaled nitric oxide is implicated in multiple disease processes but its use has been reported to cause kidney dysfunction. We wanted to study the effect of inhaled nitric oxide on kidney function as defined by creatinine and whether or not renal replacement therapy (RRT) was initiated.

METHODS: A retrospective chart review was performed to identify patients admitted to the ICU in our community hospital between 6/1/2013 to 7/1/2015, who were placed on nitric oxide for a primary respiratory problem. The creatinine was trended prior to initiation of nitric oxide and for 48 hours post initiaton of nitric oxide. Acute kidney injury (AKI) was defined as an increase in creatinine greater than 0.3 within 48 hours. Primary endpoint was whether patients required RRT. The mean arterial pressure was also documented daily to assure adequate kidney perfusion.

RESULTS: A total of 42 patients were included in the analysis. 22 patients (52%) developed AKI and of those, 9 patients (41%) required renal replacement therapy. All the patients we studied were documented to have a MAP of greater than 65 mm Hg.

CONCLUSIONS: Nitric oxide’s vasodilatory properties are transient and 70% is excreted within 48 hours as nitrate in the urine. Nitric oxide has been known to alter tubular function and increases urinary output however it becomes particularly important in the ICU, where there are many factors that could contribute to AKI in a patient coincidentally on nitric oxide, such as infection or hypotension. Our observation demonstrates that only 21% of our patients requiring nitric oxide needed some form of renal replacement therapy, hence we conclude that while it is important to monitor kidney function closely, it should not deter one’s decision to use nitric oxide.

CLINICAL IMPLICATIONS: Recent research in nitric oxide use in acute respiratory distress syndrome has linked it's use with the development of renal dysfunction. By further analyzing other factors surrounding this conclusion in these critically ill patients, we can potentially reveal it may have little to no effect at all.

DISCLOSURE: The following authors have nothing to disclose: Katherine Chiapaikeo-Poco, Killol Patel, Harish Seethamraju

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