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Kidney Week

Abstract: PO0040

Incidence of AKI After IV Vitamin C Treatment for Septic Shock: A Cohort Analysis of Real-World Application

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • McCune, Thomas R., Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Luo, Jaingtao, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Sheehan, Brynn E., Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Petr, Stephen T., Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Sherani, Muhammad K., Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Dodani, Sunita, Eastern Virginia Medical School, Norfolk, Virginia, United States
Background

Septic shock patients exhibit a high prevalence of vitamin C deficiency, and intravenous vitamin C (IVvC) may provide a survival advantage. Preliminary findings from early studies were promising, however, recent studies fail to show a benefit of vitamin C on mortality. Case reports observed that IVvC may be related to acute kidney injury(AKI) through oxalate-nephropathy. .
While IVvC in sepsis merit further research, clinicians at one institution began the use of IVvC as additional treatment for septic shock. This study is a retrospective analysis of real-world experience to evaluate the effects of IVvC on AKI in patients with septic shock

Methods

Patient-level clinical data of one 525-bed Hospital from 1 February 2016-31 December 2018 was evaluated in the current study. Institutional IRB approval was obtained and data were de-identified.
Data included patients between the ages of 18 and 89 who were hospitalized for 48 hours with 2 serum creatinines 48 hours apart or 6 hours of UOP in ICU. Patients with GFR <35ml/min (MDRD formula), creatinine > 4.0mg/dL, or diagnosis of ESRD or kidney transplant (ICD-10 codes) were excluded. Clinical data collected included; admission demographics and past history; UOP; pre-identified medications, laboratory results and order sets; specific consultations; and discharge diagnoses.

Results

A total of 22980 patient visits were evaluated. Of the 2067 patients who were admitted through the ED with a discharge diagnosis of septic shock, 433 (20.9%) received one dose of IVvC 1500mg and were categorized as the IVvC group; 1634 (79.1%) did not receive IVvC. A chi-square analysis can be seen in Table 1.

Conclusion

This retrospective study EMR observed that IVvC in the treatment of septic shock is associated with an increase in the incidence of AKI.

Table 1. Chi-square Analysis Examining the Relationship between IVvC and the Development of AKI among Inpatients with Septic Shock.
 IVvCIVvC 
AKINOYESRow Total
NO876(53.6%)134(30.9%)9951010
YES758(46.4%)299(69.0%)1057
Column Totals1634433p<.0001

Note. A logistic regression revealed that the odds of AKI were 2.57 times higher for IVvC patients compared to non-IVvC patients (95% CI 2.05,3.23)

Funding

  • Clinical Revenue Support