Intensive Care Unit–Acquired Weakness in Patients With Acute Kidney Injury: A Contemporary Review

J. Pedro Teixeira, Kirby P. Mayer, Benjamin R. Griffin, Naomi George, Nathaniel Jenkins, C. Anil Pal, Felipe González-Seguel, Javier A. Neyra

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Acute kidney injury (AKI) and intensive care unit–acquired weakness (ICU-AW) are 2 frequent complications of critical illness that, until recently, have been considered unrelated processes. The adverse impact of AKI on ICU mortality is clear, but its relationship with muscle weakness—a major source of ICU morbidity—has not been fully elucidated. Furthermore, improving ICU survival rates have refocused the field of intensive care toward improving long-term functional outcomes of ICU survivors. We begin our review with the epidemiology of AKI in the ICU and of ICU-AW, highlighting emerging data suggesting that AKI and AKI treated with kidney replacement therapy (AKI-KRT) may independently contribute to the development of ICU-AW. We then delve into human and animal data exploring the pathophysiologic mechanisms linking AKI and acute KRT to muscle wasting, including altered amino acid and protein metabolism, inflammatory signaling, and deleterious removal of micronutrients by KRT. We next discuss the currently available interventions that may mitigate the risk of ICU-AW in patients with AKI and AKI-KRT. We conclude that additional studies are needed to better characterize the epidemiologic and pathophysiologic relationship between AKI, AKI-KRT, and ICU-AW and to prospectively test interventions to improve the long-term functional status and quality of life of AKI survivors.

Original languageEnglish
Pages (from-to)336-351
Number of pages16
JournalAmerican Journal of Kidney Diseases
Volume81
Issue number3
DOIs
StatePublished - Mar 2023

Bibliographical note

Funding Information:
J. Pedro Teixeira, MD, Kirby P. Mayer, DPT, PhD, Benjamin R. Griffin, MD, Naomi George, MD, MPH, Nathaniel Jenkins, PhD, C. Anil Pal, MD, Felipe González-Seguel, PT, MSc, and Javier A. Neyra, MD, MSCS. Drs Teixeira, Mayer, Griffin, and Neyra have received funding for related research from NCATS (CORES grant U24TR002260) and our local respective National Institutes of Health CTSA program grants (University of Kentucky CTSA, UL1TR001998; University of New Mexico CTSC, UL1TR001449; and University of Iowa ICTS, UL1TR002537). These funding sources had no role in the conceptualization or realization of this article. The authors declare that they have no relevant financial interests. Received February 11, 2022. Evaluated by 2 external peer reviewers, with direct editorial input from an Associate Editor and a Deputy Editor. Accepted in revised form August 31, 2022.

Funding Information:
Drs Teixeira, Mayer, Griffin, and Neyra have received funding for related research from NCATS (CORES grant U24TR002260) and our local respective National Institutes of Health CTSA program grants (University of Kentucky CTSA, UL1TR001998; University of New Mexico CTSC, UL1TR001449; and University of Iowa ICTS, UL1TR002537). These funding sources had no role in the conceptualization or realization of this article.

Publisher Copyright:
© 2022 National Kidney Foundation, Inc.

Keywords

  • ICU-acquired weakness
  • Index Words: Acute kidney injury (AKI)
  • acute renal failure (ARF)
  • continuous kidney replacement therapy (CKRT)
  • continuous renal replacement therapy (CRRT)
  • critical illness myopathy
  • intensive care unit (ICU)
  • muscle atrophy
  • muscle wasting
  • physical rehabilitation
  • post-intensive care syndrome (PICS)
  • review

ASJC Scopus subject areas

  • Nephrology

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