Does vitamin B1 supplementation protect against kidney injury in patients with septic shock?

The TRPSS trial further revealed that patients receiving thiamine had more ICU (intensive care unit)-free days, but no difference was noted in other secondary outcomes.

In patients with septic shock, kidney injury is common and leads to worse outcomes. It is suggested that mitochondrial resuscitation with thiamine (vitamin B1) may attenuate septic kidney injury. Thiamine is known to play critical roles in several biological processes, including glucose metabolism, oxidative stress reduction, and synthesis of nucleic acids. About 70% of critically ill patients might be affected by thiamine deficiency, and thiamine supplementation appears to decrease the vasopressor dose and increase lactate clearance.

Therefore, Ari Moskowitz, Harvard Medical School, Boston, Massachusetts, United States, and colleagues aimed to assess whether thiamine supplementation attenuates kidney injury in patients with septic shock in the TRSS (Thiamine for Renal Protection in Septic Shock) trial, a multicenter, randomized, placebo-controlled trial of thiamine versus placebo in septic shock.

The study's primary outcome was a change in serum creatinine between enrollment and 72 hours after enrollment.

The authors reported the following findings:

• Eighty-eight patients were enrolled (42 received the intervention, and 46 received a placebo).
• There was no significant between-group difference in creatinine at 72 hours (mean difference -0.57 mg/dL).
• There was no difference in receipt of kidney replacement therapy (14.3% versus 21.7%), KDIGO-3 acute kidney injury (54.7% versus 73.9%), or mortality (35.7% versus 54.3%) between thiamine versus placebo groups.
• Patients who received thiamine had more intensive care unit-free days (median 22.5 versus 0.0).
• In the thiamine-deficient cohort (27.4% of patients), there was no difference in rates of kidney failure (57.1% thiamine vs. 81.5% placebo) or in-hospital mortality (28.6% versus 68.8%) between groups.

"In the TRPSS trial, there was no statistically significant difference in the primary outcome of change in creatinine over time," the researchers wrote. "Patients receiving thiamine had more ICU-free days, but no difference in other secondary outcomes."

Reference:

Moskowitz A, Berg KM, Grossestreuer AV, Balaji L, Liu X, Cocchi MN, Chase M, Gong MN, Gong J, Parikh SM, Ngo L, Berlin N, Donnino MW. Thiamine for Renal Protection in Septic Shock (TRPSS): A Randomized, Placebo-Controlled Trial. Am J Respir Crit Care Med. 2023 Jun 26. doi: 10.1164/rccm.202301-0034OC. Epub ahead of print. PMID: 37364280.