Vasopressin to reduce mortality in patients with septic shock and acute kidney injury

Abstract

Vasopressin has a multitude of functions and acts on a variety of receptors. It is subject to investigation as a rational therapy for septic shock and may have benefits in patients with acute kidney injury (AKI). Vasopressin can increase glomerular filtration rate, urine output, and creatinine clearance. Septic shock causes an initial surge then relative deficiency of vasopressin, as well as a hypersensitivity to exogenous vasopressin. In 2010, Gordon et al. published a post hoc analysis of the VASST trial and demonstrated that the mortality rates in patients with septic shock in the RIFLE “Risk” category were lower in those treated with vasopressin, but this did not reach significance in a multiple logistic regression analysis. In 2015, the VANISH study results were presented, demonstrating that early vasopressin reduced the use of renal replacement therapy in patients with septic shock but did not reduce the number of renal failure-free days or mortality.