Browsing by Author "Griffin, Benjamin"
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Publication Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study(2026) Mayer, Kirby; Teixeira, Pedro; González Seguel, Felipe; Tran, Vinh; Gross, Jessica; Horikawa, Arimitsu; Anil, Chaitanya; Shareef, Zan; Puffer, Hayley; Wen, Yuan; Griffin, Benjamin; Neyra, JavierPurpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking. Materials and methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty. Results: Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m2, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW. Conclusions: Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge. Trial registration: NCT05287204, Registered 20 October 2021.Item Intensive Care Unit-Acquired Weakness in Patients With Acute Kidney Injury: A Contemporary Review(2022) Teixeira, Pedro; Mayer, Kirby; Griffin, Benjamin; George, Naomi; Jenkins, Nathaniel; Pal, Anil; González, Felipe; Neyra, JavierAcute 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.