The following is a summary of “Impact of AKI on metabolic compensation for respiratory acidosis in ICU patients with AECOPD,” published in the October 2024 issue of Critical Care by Marcy et al. 

Researchers conducted a retrospective study to determine the effect of acute kidney injury (AKI) on renal compensation for respiratory acidosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).  

They reviewed clinical records from January 2009 to December 2021, analyzing data from 498 intensive care unit (ICU) individuals with AECOPD requiring respiratory support.  

The results showed that 278 individuals (55.8%) developed AKI and had higher 30-day mortality rates (14.5% vs 4.5%; P = 0.001), with longer mechanical ventilation (median 90 hours vs 14 hours; P = 0.001), and had more severe hypercapnic acidosis (pH 7.23 vs 7.28; pCO₂ 68.5 mmHg vs. 61.8 mmHg). The Higher AKI stages were associated with lower HCO₃^– /pCO₂ ratios and failure to reach expected HCO₃^– levels. A mixed model analysis with random intercepts per individual demonstrated that severe AKI resulted in lower estimates for average changes in HCO₃^– relative to pCO². Patients with more severe AKI observed lower estimates in HCO₃^–.   

Investigators concluded that AKI was associated with poor outcomes and impaired renal compensation for respiratory acidosis in patients with AECOPD in ICU, and the use of buffering agents aiding compensation for severe AKI, should be considered cautiously. 

Source: sciencedirect.com/science/article/pii/S0883944124003332