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

Am J Kidney Dis. 2023 Mar;81(3):336-351. doi: 10.1053/j.ajkd.2022.08.028. Epub 2022 Nov 2.

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.

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.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury* / therapy
  • Critical Care
  • Critical Illness
  • Humans
  • Intensive Care Units
  • Quality of Life*
  • Renal Replacement Therapy / adverse effects