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intensity of renal support in critically ill patients with acute kidney injury

Michael Schmitz, Frank P Tillmann, Ausra Paluckaite, Erich A Laufer, Brian Rayner, Lars C Rump, Peter J Heering
BACKGROUND: Mortality of critically-ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) in an intensive-care setting continues to remain high. There is still uncertainty as to which factors should guide clinical judgement. METHODS: A cohort of 155 patients admitted to an intensive-care unit and necessitating RRT due to AKI were retrospectively analyzed. Demographic and clinical parameters at the time of RRT initiation were retrieved...
April 21, 2017: Clinical Nephrology
Emma Mj Borthwick, Christopher J Hill, Kannaiyan S Rabindranath, Alexander P Maxwell, Danny F McAuley, Bronagh Blackwood
BACKGROUND: Severe sepsis and septic shock are leading causes of death in the intensive care unit (ICU), despite advances in the treatment of patients with severe sepsis and septic shock, including early recognition, appropriate treatment with antibiotics and support of organs that may have been affected by the illness. High-volume haemofiltration (HVHF) is a blood purification technique that may improve outcomes in severe sepsis or septic shock. The technique of HVHF has evolved from renal replacement therapies used in the ICU to treat critically ill patients with acute kidney injury (AKI)...
January 31, 2017: Cochrane Database of Systematic Reviews
D J Askenazi, Michael Heung, Michael J Connor, Rajit K Basu, Jorge Cerdá, Kent Doi, Jay L Koyner, Azra Bihorac, Ladan Golestaneh, Anitha Vijayan, Mark D Okusa, Sarah Faubel
As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU...
2017: Blood Purification
Yahya Acar, Onur Tezel, Necati Salman, Erdem Cevik, Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-Bordomás, Mustafa Z Mahmoud, Abdelmoneim Sulieman, Abbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H Lester Kirchner, Gregor Prosen, Ajda Anzic, Paul Leeson, Maryam Bahreini, Fatemeh Rasooli, Houman Hosseinnejad, Gabriel Blecher, Robert Meek, Diana Egerton-Warburton, Edina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz Kovačević, Nadan Rustemović, Ikwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun Kim, Chi-Yung Cheng, Hsiu-Yung Pan, Chia-Te Kung, Ela Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan Radonić, Abiola Fasina, Anthony J Dean, Nova L Panebianco, Patricia S Henwood, Oliviero Fochi, Moreno Favarato, Ezio Bonanomi, Ivan Tomić, Youngrock Ha, Hongchuen Toh, Elizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Angela Hua, Sharon Kim, James Tsung, Isa Gunaydin, Zeynep Kekec, Mehmet Oguzhan Ay, Jinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon Shim, Ji-Han Lee, Jana Ambrozic, Katja Prokselj, Miha Lucovnik, Gabrijela Brzan Simenc, Asta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius Macas, Sharad Mohite, Zoltan Narancsik, Hugon Možina, Sara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Simon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard Kaufmann, Chun-I Pan, Chien-Hung Wu, Sarah Pasquale, Stephanie J Doniger, Sharon Yellin, Gerardo Chiricolo, Maja Potisek, Borut Drnovšek, Boštjan Leskovar, Kristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph Minardi, Irmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar Zubovic, Ana Godan Hauptman, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Vedran Radonic, Luka Bielen, Peh Wee Ming, Nur Hafiza Yezid, Fatahul Laham Mohammed, Zainal Abidin Huda, Wan Nasarudin Wan Ismail, W Yus Haniff W Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan
A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization...
September 2016: Critical Ultrasound Journal
Alexander Zarbock, John A Kellum, Christoph Schmidt, Hugo Van Aken, Carola Wempe, Hermann Pavenstädt, Andreea Boanta, Joachim Gerß, Melanie Meersch
IMPORTANCE: Optimal timing of initiation of renal replacement therapy (RRT) for severe acute kidney injury (AKI) but without life-threatening indications is still unknown. OBJECTIVE: To determine whether early initiation of RRT in patients who are critically ill with AKI reduces 90-day all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: Single-center randomized clinical trial of 231 critically ill patients with AKI Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 (≥2 times baseline or urinary output <0...
May 24, 2016: JAMA: the Journal of the American Medical Association
Jennifer G Wilson, Kristine E W Breyer
The use of point-of-care ultrasound in the intensive care unit, both for diagnostic and procedural purposes, has rapidly proliferated, and evidence supporting its use is growing. Conceptually, critical care ultrasound (CCUS) should be considered an extension of the physical examination and should not be considered a replacement for formal echocardiography or radiology-performed ultrasound. Several CCUS applications are of particular relevance to nephrologists, including focused renal ultrasound in patients at high risk for urinary tract obstruction, real-time ultrasound guidance and verification during the placement of central venous catheters, and ultrasound-augmented assessment of shock and volume status...
May 2016: Advances in Chronic Kidney Disease
Sérgio Mina Gaião, André Amaral Gomes, José Artur Osório de Carvalho Paiva
OBJECTIVE: Identify prognostic factors related to mortality and non-recovery of renal function. METHODS: A prospective single-center study was conducted at the intensive care medicine department of a university hospital between 2012 and 2015. Patients with acute kidney injury receiving continuous renal replacement therapy were included in the study. Clinical and analytical parameters were collected, and the reasons for initiation and discontinuation of renal replacement therapy were examined...
January 2016: Revista Brasileira de Terapia Intensiva
Stefano Romagnoli, Zaccaria Ricci, Claudio Ronco
In modern intensive care medicine, lungs and kidneys frequently are involved in the context of multiorgan failure. When organ dysfunction occurs, the primary clinical management of critically ill patients is based on support/replacement of organ function until recovery. Mechanical ventilation is the first-line intervention in case of respiratory failure, but in most severe cases may, itself, cause ventilator-induced lung injury. The same inflammatory mechanism also may harm the kidney through mediator spillover from the injured lungs into the bloodstream...
January 2016: Seminars in Nephrology
Amy N McCammond, David M Axelrod, David K Bailly, E Zachary Ramsey, John M Costello
OBJECTIVE: In this Consensus Statement, we review the etiology and pathophysiology of fluid disturbances in critically ill children with cardiac disease. Clinical tools used to recognize pathologic fluid states are summarized, as are the mechanisms of action of many drugs aimed at optimal fluid management. DATA SOURCES: The expertise of the authors and a review of the medical literature were used as data sources. DATA SYNTHESIS: The authors synthesized the data in the literature in order to present clinical tools used to recognize pathologic fluid states...
March 2016: Pediatric Critical Care Medicine
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco
During the last few years, due to medical and surgical evolution, patients with increasingly severe diseases causing multiorgan dysfunction are frequently admitted to intensive care units. Therapeutic options, when organ failure occurs, are frequently nonspecific and mostly directed towards supporting vital function. In these scenarios, the kidneys are almost always involved and, therefore, renal replacement therapies have become a common routine practice in critically ill patients with acute kidney injury...
2016: F1000Research
Michael Oppert
Acute kidney injury (AKI) is a frequent finding in patients with critical illness. In many of these patients renal replacement therapy (RRT) is needed to support organ dysfunction. Although international guidelines on the management of AKI have been developed and are widely accepted, there is still considerable controversy on the optimal timing of RRT. The clinician is in a constant dilemma that level of evidence (on timing of acute RRT) is low and the issue is of high importance. Despite this paucity of high quality prospective data, this review will give the reader an idea on how to approach the difficult question of initiating RRT...
February 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Oleksa Rewa, Ron Wald, Neill K J Adhikari, Michelle Hladunewich, Stephen Lapinsky, John Muscedere, Sean M Bagshaw, Orla M Smith, Gerald Lebovic, Rottem Kuint, David J Klein
PURPOSE: Acute kidney injury is common in intensive care units and is associated with increased morbidity and mortality. We evaluated the ability of whole-blood neutrophil gelatinase-associated lipocalin (wbNGAL) to predict mortality and need for renal replacement therapy (RRT) in critically ill patients with kidney dysfunction. METHODS: We prospectively enrolled adult patients in 5 Canadian intensive care units. We measured wbNGAL at the time of enrollment to determine whether NGAL concentration could predict the primary composite outcome of death or need for RRT by day 30 in addition to other secondary outcomes...
December 2015: Journal of Critical Care
Tobias Kammerer, Florian Klug, Michaela Schwarz, Sebastian Hilferink, Bernhard Zwissler, Vera von Dossow, Alexander Karl, Hans-Helge Müller, Markus Rehm
BACKGROUND: The use of artificial colloids is currently controversial, especially in Central Europe Several studies demonstrated a worse outcome in intensive care unit patients with the use of hydroxyethyl starch. This recently even led to a drug warning about use of hydroxyethyl starch products in patients admitted to the intensive care unit. The data on hydroxyethyl starch in non-critically ill patients are insufficient to support perioperative use. METHODS/DESIGN: We are conducting a single-center, open-label, randomized, comparative trial with two parallel patient groups to compare human albumin 5% (test drug) with hydroxyethyl starch 6% 130/0...
August 28, 2015: Trials
Enrico Fiaccadori, Giuseppe Regolisti, Aderville Cabassi
Patients who develop AKI, especially in the intensive care unit (ICU), are at risk of protein-energy malnutrition, which is a major negative prognostic factor in this clinical condition. Despite the lack of evidence from controlled trials of its effect on outcome, nutritional support by the enteral (preferentially) and/or parenteral route appears clinically indicated in most cases of ICU-acquired AKI, independently of the actual nutritional status of the patient, in order to prevent deterioration in the nutritional state with all its known complications...
February 2010: NDT Plus
Andrew Davenport, Ashita Tolwani
Continuous forms of renal replacement therapy (CRRT) have become established as the treatment of choice for supporting critically ill patients with acute kidney injury. Typically, these patients have activation of the coagulation cascades, peripheral mononuclear cells and platelets, but also a reduction in natural anticoagulants, and are therefore prothrombotic. For continuous modes of renal replacement therapy to be effective, in terms of both effective solute clearance and also fluid removal, the extracorporeal circuits must operate continuously...
December 2009: NDT Plus
Stéphane Gaudry, David Hajage, Fréderique Schortgen, Laurent Martin-Lefevre, Florence Tubach, Bertrand Pons, Eric Boulet, Alexandre Boyer, Nicolas Lerolle, Guillaume Chevrel, Dorothée Carpentier, Alexandre Lautrette, Anne Bretagnol, Julien Mayaux, Marina Thirion, Philippe Markowicz, Guillemette Thomas, Jean Dellamonica, Jack Richecoeur, Michael Darmon, Nicolas de Prost, Hodane Yonis, Bruno Megarbane, Yann Loubières, Clarisse Blayau, Julien Maizel, Benjamin Zuber, Saad Nseir, Naïke Bigé, Isabelle Hoffmann, Jean-Damien Ricard, Didier Dreyfuss
BACKGROUND: There is currently no validated strategy for the timing of renal replacement therapy (RRT) for acute kidney injury (AKI) in the intensive care unit (ICU) when short-term life-threatening metabolic abnormalities are absent. No adequately powered prospective randomized study has addressed this issue to date. As a result, significant practice heterogeneity exists and may expose patients to either unnecessary hazardous procedures or undue delay in RRT. METHODS/DESIGN: This is a multicenter, prospective, randomized, open-label parallel-group clinical trial that compares the effect of two RRT initiation strategies on overall survival of critically ill patients receiving intravenous catecholamines or invasive mechanical ventilation and presenting with AKI classification stage 3 (KDIGO 2012)...
April 17, 2015: Trials
Abdeen R Farah Musa, Tibor Fülöp, Kenneth Kokko, Béla Kanyicska, Jack R Lewin, Éva Csongrádi
BACKGROUND: Historically, cytomegalovirus (CMV) infection in immunocompetent patients has been considered to have a relatively indolent and self-limited course, not warranting specific treatment. CASE PRESENTATION: We are presenting a 72-year-old African-American male transferred to our intensive care unit (ICU) with methicillin-resistant Staphylococcus aureus bacteremia, respiratory failure, and dialysis-dependent acute kidney injury. While he recovered from bacteremia, he remained difficult to wean from respiratory support, had labile blood pressure, and manifested persistent diarrhea...
July 2015: Clinical Nephrology
E Fiaccadori, A Sabatino, S Morabito, L Bozzoli, C Donadio, U Maggiore, G Regolisti
Derangements of glucose metabolism are common among critically ill patients. Critical illness- associated hyperglycemia (CIAH) is characterized by raised blood glucose levels in association with an acute event that is reversible after resolution of the underlying disease. CIAH has many causes, such as changes in counter-regulatory hormone status, release of sepsis mediators, insulin resistance, drugs and nutritional factors. It is associated with increased mortality risk. This association appears to be strongly influenced by diabetes mellitus as a comorbidity, suggesting the need for an accurate individualization of glycemic targets according to baseline glycemic status...
January 2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Christopher Thiam Seong Lim, Han Khim Tan, Yeow Kok Lau
OBJECTIVE: Critically ill patients with acute kidney injury (AKI) frequently need acute renal replacement therapy (aRRT). We evaluated an inexpensive, rapid quantitative and qualitative analysis of proteinuria on the course of AKI patients requiring aRRT in intensive care. METHOD: This was a prospective, observational study of critically ill patients with severe established AKI or Acute on Chronic Kidney Injury (AoCKI) requiring aRRT. Urine samples were analyzed using Sodium-Dodecyl-Sulphate-Polyacryamide Gel Electrophoresis (SDS-PAGE)...
November 2014: Pakistan Journal of Medical Sciences Quarterly
Hideto Yasuda, Shigehiko Uchino, Makiko Uji, Tetsu Ohnuma, Yoshitomo Namba, Shinshu Katayama, Hiroo Kawarazaki, Noriyoshi Toki, Kenta Takeda, Junichi Izawa, Natsuko Tokuhira, Isao Nagata
INTRODUCTION: The recommended lower limit of intensity during continuous renal replacement therapy (CRRT) is 20 or 25 mL/kg/h. However, limited information is available to support this threshold. We aimed to evaluate the impact of different intensities of CRRT on the clearance of creatinine and urea in critically ill patients with severe acute kidney injury (AKI). METHODS: This is a multicenter retrospective study conducted in 14 Japanese ICUs in 12 centers. All patients older than 18 years and treated with CRRT due to AKI were eligible...
2014: Critical Care: the Official Journal of the Critical Care Forum
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