Management of Sepsis and Acute Kidney Injury

Glycemic Control

The Surviving Sepsis Campaign recommends targeting blood glucose ≤180 mg/dL, rather than tight control, to avoid hypoglycemia risk without mortality benefit in patients with sepsis 1, 2
Insulin clearance is impaired in patients with AKI and sepsis, increasing hypoglycemia risk, and consideration should be given to reducing insulin doses 3
Rapid correction of chronic hyperglycemia in diabetic patients with previous poor control may worsen outcomes, suggesting avoiding aggressive titration 4

The Surviving Sepsis Campaign suggests against using RRT in patients with sepsis and AKI for increased creatinine or oliguria without other definitive indications for dialysis 1, 2
If RRT becomes necessary, use continuous renal replacement therapy (CRRT) rather than intermittent hemodialysis for hemodynamically unstable patients 1, 2, 5

Monitor for fluid overload given bipedal edema and AKI; if edema worsens or respiratory symptoms develop, consider diuretic therapy cautiously 1, 5
Transition to heplock is appropriate given resolved septic shock and adequate urine output, but maintain close hemodynamic monitoring 1, 5

Telmisartan 40mg OD should be held or used cautiously in AKI stage 3, as ACE inhibitors/ARBs can worsen renal function in acute kidney injury 4
VTE prophylaxis should be initiated with dalteparin (preferred LMWH with low renal metabolism) or UFH given creatinine clearance <30 mL/min, combined with intermittent pneumatic compression devices 2, 6

Blood glucose should be monitored every 2-4 hours until stable on current insulin regimen 1, 2
Daily creatinine and electrolytes should be assessed to monitor AKI recovery 4
Urine output should be monitored (target >0.5 mL/kg/hr) to assess renal function 5