Thiamine Offers Renal Protection in Septic Shock

TOPLINE:

Intravenous thiamine supplementation causes a decline in renal replacement therapy (RRT) requirement in patients with septic shock, particularly in those with thiamine deficiency.

METHODOLOGY:

• Renal injury is common in patients with septic shock. In previous studies, although the effects of thiamine supplementation were evaluated in patients with septic shock, renal outcomes were not specifically assessed.
• A post hoc analysis of 158 patients (median age, 70 years) with septic shock from two trials (thiamine in septic shock and thiamine for renal protection in septic shock) was conducted.
• Participants were randomly assigned to receive either thiamine supplementation (n=73) or placebo (n=85).
• The primary outcome was RRT-free survival.

TAKEAWAY:

• Patients receiving thiamine supplementation vs placebo showed a higher likelihood of RRT-free survival at discharge (adjusted odds ratio [aOR], 2.05; P =.029).
• A significantly higher number of patients in the thiamine group did not receive RRT (aOR, 2.59; P =.048).
• In the thiamine-deficient patients, thiamine supplementation was associated with higher odds of RRT-free survival at discharge (aOR, 8.17; P =.007).

IN PRACTICE:

The administration of intravenous thiamine demonstrated that a high percentage of patients survived without requiring RRT, and this benefit was more pronounced among patients with low thiamine levels, the authors concluded.

SOURCE:

This study was led by Jacob Vine, from the Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and published in Critical Care.

LIMITATIONS:

This was a post hoc analysis. Also, the measurement of plasma thiamine levels was restricted to the trials analyzed in this study.

DISCLOSURES:

Thiamine in Septic Shock and Thiamine for Renal Protection in Septic Shock Trials were supported by the National Institute of General Medical Sciences Grant and the National Institute of Alternative and Complementary Medicine Grant. The work conducted by some of the authors was supported by the National Heart, Lung, and Blood Institute Grant. The authors declared no conflicts of interest.