Sepsis & Acute Kidney Injury
Sepsis is the leading cause of acute kidney injury in the ICU, affecting up to 50% of septic patients. Our rapid-response nephrology team provides 24/7 CRRT and dialysis support for your most critical patients.
Understanding Sepsis-Induced AKI
Sepsis-associated acute kidney injury (SA-AKI) occurs when the body's overwhelming response to infection causes kidney damage. Unlike other forms of AKI, septic kidneys often fail despite adequate blood pressure and fluid resuscitation.
Key mechanisms include:
- Microvascular dysfunction: Inflammation disrupts kidney blood flow at the capillary level
- Tubular injury: Inflammatory cytokines directly damage kidney cells
- Mitochondrial dysfunction: Cellular energy production fails
- Fluid overload: Aggressive resuscitation can worsen kidney perfusion
When to Call for Nephrology Support
Early consultation improves outcomes. Don't wait for complete renal failure—early CRRT can help manage fluid balance and metabolic derangements while optimizing sepsis treatment.
Our Approach to Sepsis-AKI
Specialized protocols designed for the unique challenges of septic kidney injury
Rapid CRRT Deployment
On-site within 2 hours for emergencies. Pre-positioned equipment at partner facilities for even faster response.
Precision Fluid Management
Hourly fluid targets coordinated with your ICU team. CRRT allows precise volume control while optimizing sepsis treatment.
Metabolic Optimization
Continuous correction of acidosis, electrolytes, and uremic toxins. Enables optimal antibiotic dosing.
Hemodynamic Support
CRRT is gentler than intermittent HD. Better tolerated in patients on vasopressors with unstable blood pressure.
Integrated ICU Care
Our nephrologists and nurses work alongside your ICU team. Coordinated rounds, shared goals, seamless communication.
Recovery Planning
Continuous monitoring for kidney recovery. Transition from CRRT to intermittent HD as patient stabilizes.
For Intensivists & Critical Care Teams
We understand the complexity of managing septic patients. Our nephrology team integrates seamlessly with your workflow, providing expert renal support without disrupting your protocols.
- 24/7 attending nephrology coverage—not just fellows
- CRRT machines positioned at partner ICUs for immediate deployment
- Antibiotic dosing guidance during CRRT
- Citrate anticoagulation for patients with bleeding risk
- Daily collaborative rounds with ICU team
- Real-time adjustment of CRRT prescription to clinical needs
Clinical Protocols
KDIGO Guidelines
AKI staging and management per international guidelines
Surviving Sepsis Integration
Renal support aligned with sepsis bundles and resuscitation goals
CRRT Dosing
20-25 mL/kg/hr effluent dose per evidence-based recommendations
Frequently Asked Questions
When should CRRT be initiated in septic AKI?
There's no absolute creatinine threshold. We consider CRRT when there's refractory volume overload, severe metabolic acidosis (pH <7.2), hyperkalemia (K+ >6.5), or uremic symptoms. Early consultation allows us to plan timing based on trajectory rather than waiting for emergent indications.
Does CRRT improve survival in sepsis?
CRRT provides renal replacement and fluid management but hasn't been shown to improve mortality through cytokine removal alone. Its primary benefit is maintaining metabolic stability and enabling optimal sepsis treatment. The key is using it as part of comprehensive sepsis care, not as a standalone intervention.
How do you manage anticoagulation in septic patients?
We primarily use regional citrate anticoagulation (RCA) for patients with bleeding risk or coagulopathy. For patients without bleeding concerns, we may use systemic heparin. Our protocols minimize systemic anticoagulation exposure while maintaining circuit patency.
Can you dose antibiotics during CRRT?
Yes, we provide antibiotic dosing guidance accounting for CRRT clearance. Many antibiotics require dose adjustment during continuous therapies. Our pharmacist collaborates with your team to optimize antimicrobial dosing.
What's your response time for emergencies?
For established partner facilities with pre-positioned equipment, we can typically initiate CRRT within 2 hours. For new facilities, response time depends on equipment transport but we prioritize urgent cases.
Need Nephrology Support for Your ICU?
Whether you have an acute sepsis case or want to establish a CRRT program at your facility, we're here to help. Contact us for a consultation.