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Advances in Chronic Kidney Disease

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https://www.readbyqxmd.com/read/29031361/treatment-of-disorders-of-sodium-balance-in-chronic-kidney-disease
#1
REVIEW
David H Ellison
Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031360/sodium-homeostasis-in-chronic-kidney-disease
#2
REVIEW
Vivek Soi, Jerry Yee
The pathologic consequences of sodium retention in the CKD population can lead to hypertension, edema, and progressive disease. Sodium excess is responsible for increases in oxidative stress, which alters kidney vasculature. As progression of CKD occurs, hyperfiltration by remaining nephrons compensates for an overall decrease in the filtered load of sodium. In the later stages of CKD, compensatory mechanisms are overcome and volume overload ensues. Nephrotic syndrome as it relates to sodium handling involves a different pathophysiology despite a common phenotype...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031359/treatment-of-abnormalities-of-potassium-homeostasis-in-ckd
#3
REVIEW
Biff F Palmer, Deborah J Clegg
Hyperkalemia, defined as serum potassium concentrations greater than 5.0 to 5.5 mEq/L, is a frequent occurrence in clinical practice because of the increasing incidence and prevalence of CKD. Patients at risk for this disorder are commonly treated with drugs that interfere in the renin-angiotensin-aldosterone system, thereby enhancing the occurrence and prevalence of this disorder. Discontinuation of these drugs because of the development of hyperkalemia deprives these patients the renal-protective and cardiovascular benefits this class of pharmacology has been shown to provide...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031358/hyperkalemia-and-hypokalemia-in-ckd-prevalence-risk-factors-and-clinical-outcomes
#4
REVIEW
Sarah Gilligan, Kalani L Raphael
Abnormalities of serum potassium are common in patients with CKD. Although hyperkalemia is a well-recognized complication of CKD, the prevalence rates of hyperkalemia (14%-20%) and hypokalemia (12%-18%) are similar. CKD severity, use of medications such as renin-angiotensin-aldosterone system inhibitors and diuretics, and dietary potassium intake are major determinants of serum potassium concentration in CKD. Demographic factors, acid-base status, blood glucose, and other comorbidities contribute as well. Both hyperkalemia and hypokalemia are associated with similarly increased risks of death, cardiovascular disease, and hospitalization...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031357/regulation-of-potassium-homeostasis-in-ckd
#5
REVIEW
Thomas D DuBose
Disturbances of potassium homeostasis can cause either hyperkalemia or hypokalemia and result in serious consequences. Although the consequences of acute and chronic hyperkalemia and treatment of these conditions in CKD have been widely appreciated by nephrologists, more recent information has focused attention on the consequences of chronic hypokalemia. Several recent studies have documented a "U-shaped" relationship between the serum [K(+)] and higher mortality in several clinical studies. The causes of dyskalemias are placed into the unique perspective of patients with CKD and its evolution with progression of CKD to later stages and focuses on the pathophysiology of these disorders...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031356/management-of-the-metabolic-acidosis-of-chronic-kidney-disease
#6
REVIEW
Nimrit Goraya, Donald E Wesson
Subjects with CKD and reduced glomerular filtration rate are at risk for chronic metabolic acidosis, and CKD is its most common cause. Untreated metabolic acidosis, even in its mildest forms, is associated with increased mortality and morbidity and should therefore be treated. If reduced glomerular filtration rate or the tubule abnormality causing chronic metabolic acidosis cannot be corrected, it is typically treated with dietary acid (H(+)) reduction using Na(+)-based alkali, usually NaHCO3. Dietary H(+) reduction can also be accomplished with the addition of base-producing foods such as fruits and vegetables and limiting intake of H(+)-producing foods like animal-sourced protein...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031355/adverse-effects-of-the-metabolic-acidosis-of-chronic-kidney-disease
#7
REVIEW
Jeffrey A Kraut, Nicolaos E Madias
The kidney has the principal role in the maintenance of acid-base balance, and therefore, a fall in renal net acid excretion and positive H(+) balance often leading to reduced serum [HCO3(-)] are observed in the course of CKD. This metabolic acidosis can be associated with muscle wasting, development or exacerbation of bone disease, hypoalbuminemia, increased inflammation, progression of CKD, protein malnutrition, alterations in insulin, leptin, and growth hormone, and increased mortality. Importantly, some of the adverse effects can be observed even in the absence of overt hypobicarbonatemia...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031354/epidemiology-of-acid-base-derangements-in-ckd
#8
REVIEW
Wei Chen, Matthew K Abramowitz
Acid-base disorders are in patients with chronic kidney disease, with chronic metabolic acidosis receiving the most attention clinically in terms of diagnosis and treatment. A number of observational studies have reported on the prevalence of acid-base disorders in this patient population and their relationship with outcomes, mostly focusing on chronic metabolic acidosis. The majority have used serum bicarbonate alone to define acid-base status due to the lack of widely available data on other acid-base disorders...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031353/regulation-of-acid-base-balance-in-chronic-kidney-disease
#9
REVIEW
Glenn T Nagami, L Lee Hamm
The kidneys play a major role in the regulation of acid-base balance by reabsorbing bicarbonate filtered by the glomeruli and excreting titratable acids and ammonia into the urine. In CKD, with declining kidney function, acid retention and metabolic acidosis occur, but the extent of acid retention depends not only on the degree of kidney impairment but also on the dietary acid load. Acid retention can occur even when the serum bicarbonate level is apparently normal. With reduced kidney function, acid transport processes in the surviving nephrons are augmented but as disease progresses ammonia excretion and, in some individuals, the ability to reabsorb bicarbonate falls, whereas titratable acid excretion is preserved until kidney function is severely impaired...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031352/disturbances-in-acid-base-potassium-and-sodium-balance-in-patients-with-ckd-new-insights-and-novel-therapies
#10
EDITORIAL
Jeffrey A Kraut
No abstract text is available yet for this article.
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031351/hyperkalemia-inpatient-panik
#11
EDITORIAL
Jerry Yee
No abstract text is available yet for this article.
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778367/getting-to-the-heart-of-the-matter-review-of-treatment-of-cardiorenal-syndrome
#12
REVIEW
Kausik Umanath, Sitaramesh Emani
Acute decompensated heart failure is a common cause of hospitalization with worsening kidney function or acute kidney injury often complicating the admission, which can result in further dysfunction of both systems in the form of a cardiorenal syndrome. Therapy in this arena has been largely empiric as rigorous clinical trial data to inform therapeutic choices are lacking. Here we review and discuss the available clinical evidence for common approaches to the management of this condition. A multidisciplinary approach to the care of patients with cardiorenal syndrome that relies on the experience of nephrologists and cardiologists to individualize treatment is critical given the paucity of rigorous clinical trial data...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778366/dual-organ-duel-the-hepatorenal-axis
#13
REVIEW
Ladan Golestaneh, Joel Neugarten
Recent developments in our understanding of the pathogenesis of kidney disease in the setting of liver failure have highlighted that kidney injury, rather than occurring in isolation, is a marker of systemic disease and poor prognosis. The differential diagnosis of kidney disease associated with liver failure is broader than formerly described and new biopsy data, along with better acute kidney injury classification tools, have increased appreciation for distinct pathophysiological mechanisms. Evidence suggests that acute kidney injury contributes to worsening hepatic failure by directly injuring hepatic cells and by imposing restrictions on therapeutic strategies for portal hypertension...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778365/follow-up-care-in-acute-kidney-injury-lost-in-transition
#14
REVIEW
Samuel A Silver, Edward D Siew
Acute kidney injury (AKI) is an increasingly common condition that is associated with long-term health outcomes. Recent studies have demonstrated that AKI, particularly when severe or persistent, is associated with all-cause mortality, CKD, ESRD, cardiovascular events, and reduced quality of life. However, data from multiple health care systems indicate that most patients do not see a nephrologist, although 1 study has suggested patients with AKI requiring dialysis may benefit from doing so. These observations raise the greater questions of what are the elements of care that may improve outcomes in survivors of AKI and which survivors need to be seen...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778364/information-technology-and-acute-kidney-injury-alerts-alarms-bells-and-whistles
#15
REVIEW
F Perry Wilson
The goal of this review is to describe the rationale for alerting systems for acute kidney injury, the challenges associated with alert implementation, and the efficacy (or lack thereof) of acute kidney injury alerts to date.
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778363/kidney-toxicities-associated-with-novel-cancer-therapies
#16
REVIEW
Joannie Lefebvre, Ilya G Glezerman
Targeted therapies that act via unique molecular pathways and interfere with cancer cell growth and tumor progression have dramatically changed the cancer treatment paradigm. However, although, ideally, these therapies intend to target only cancer cells, they do often affect nonmalignant tissue. Numerous renal side effects have been reported to date. This article will review clinical presentation, presumed pathophysiology, and treatment of kidney side effects of targeted therapies. Feasibility of the continuation of cancer therapy despite renal toxicity will also be addressed...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778362/acute-kidney-injury-in-transplant-setting-differential-diagnosis-and-impact-on-health-and-health-care
#17
REVIEW
Bassam G Abu Jawdeh, Amit Govil
Acute kidney injury (AKI) is common in kidney transplant recipients. In addition to the usual causes of AKI in native kidneys, certain features and risk factors are unique to kidney allografts. In this article, we will present an overview of the common transplant-specific AKI etiologies that include increased susceptibility to hemodynamic-mediated AKI, acute rejection, medication-induced AKI, recurrence of native kidney disease, infections, urinary tract obstruction, vascular thrombosis and post-transplant lymphoproliferative disorder...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778361/antibiotic-dosing-in-continuous-renal-replacement-therapy
#18
REVIEW
Alexander R Shaw, Bruce A Mueller
Appropriate antibiotic dosing is critical to improve outcomes in critically ill patients with sepsis. The addition of continuous renal replacement therapy makes achieving appropriate antibiotic dosing more difficult. The lack of continuous renal replacement therapy standardization results in treatment variability between patients and may influence whether appropriate antibiotic exposure is achieved. The aim of this study was to determine if continuous renal replacement therapy effluent flow rate impacts attaining appropriate antibiotic concentrations when conventional continuous renal replacement therapy antibiotic doses were used...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778360/continuous-renal-replacement-therapy-reviewing-current-best-practice-to-provide-high-quality-extracorporeal-therapy-to-critically-ill-patients
#19
REVIEW
Michael J Connor, Nithin Karakala
Continuous renal replacement therapy (CRRT) use continues to expand globally. Despite improving technology, CRRT remains a complex intervention. Delivery of high-quality CRRT requires close collaboration of a multidisciplinary team including members of the critical care medicine, nephrology, nursing, pharmacy, and nutrition support teams. While significant gaps in medical evidence regarding CRRT persist, the growing evidence base supports evolving best practice and consensus to define high-quality CRRT. Unfortunately, there is wide variability in CRRT operating characteristics and limited uptake of these best practices...
July 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28778359/fluid-resuscitation-principles-of-therapy-and-kidney-safe-considerations
#20
REVIEW
Ajay Srivastava
Fluid resuscitation in the acutely ill must take into consideration numerous elements, including the intravenous solution itself, the phase of resuscitation, and the strategies toward volume management which are paramount. With the advancement in the understanding and implementation of aggressive fluid resuscitation has also come a greater awareness of the resultant fluid toxicity, especially in those that suffer acute kidney injury, and the realization that there is continued ambiguity with regard to volume mitigation and removal in the resuscitated patient...
July 2017: Advances in Chronic Kidney Disease
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