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timing of renal replacement therapy

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https://www.readbyqxmd.com/read/29673370/early-versus-standard-initiation-of-renal-replacement-therapy-in-furosemide-stress-test-non-responsive-acute-kidney-injury-patients-the-fst-trial
#1
Nuttha Lumlertgul, Sadudee Peerapornratana, Thananda Trakarnvanich, Wanjak Pongsittisak, Kajbundit Surasit, Anan Chuasuwan, Pleumjit Tankee, Khajohn Tiranathanagul, Kearkiat Praditpornsilpa, Kriang Tungsanga, Somchai Eiam-Ong, John A Kellum, Nattachai Srisawat
BACKGROUND: The timing of initiation of renal replacement therapy (RRT) in severe acute kidney injury (AKI) remains controversial, with early initiation resulting in unnecessary therapy for some patients while expectant therapy may delay RRT for other patients. The furosemide stress test (FST) has been shown to predict the need for RRT and therefore could be used to exclude low-risk patients from enrollment in trials of RRT timing. We conducted this multicenter pilot study to determine whether FST could be used to screen patients at high risk for RRT and to determine the feasibility of incorporating FST into a trial of early initiation of RRT...
April 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29664506/continuous-venovenous-hemofiltration-in-neonates-with-hyperammonemia-a-case-series
#2
Felipe Cavagnaro Santa María, Jorge Roque Espinosa, Pamela Guerra Hernández
INTRODUCTION: Neonatal hyperammonemia secondary due to inborn errors of metabolism is a rare condition with a high rate of neurological sequelae and mortality. Initial medical management is often insufficient to stop the progressive increase of ammonia, with the consequent deterioration of the patient. For this reason, depurative techniques have been implemented, including peritoneal dialysis, intermittent hemodialysis and continuous renal replacement therapy (CRRT). OBJECTIVE: To describe our experience with continuous extracorporeal dialysis in severely ill neonates with hyperammonemia...
February 2018: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29663999/-analysis-of-high-risk-factors-of-intensive-care-unit-acquired-weakness-in-patients-with-sepsis
#3
Xiaofan Yu, Xiaohong Wan, Linjun Wan, Qingqing Huang
OBJECTIVE: To investigate high risk factors of intensive care unit-acquired weakness (ICUAW) in patients with sepsis. METHODS: A retrospective study was conducted. 164 patients with mechanical ventilation (MV) who were diagnosed sepsis and multiple organ dysfunction syndrome (MODS), admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Kunming Medical University from January 1st, 2015 to September 30th, 2017 were enrolled. The general situation, the basic diseases (hypertension, diabetes), body mass index (BMI), protopathy diseases, the level of albumin before ICU admission, the MV time, whether to use glucocorticoid and continuous renal replacement therapy (CRRT) or not, nutrition supply (nutritional way, nutrition initiation time, amino acid/protein supply, nutritional status on ICU 3 days and 7 days), myoglobin, the length of ICU stay, the length of hospital stay, and acute physiology and chronic health evaluation II (APACHE II) score were collected...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29658916/microdissection-of-primary-renal-tissue-segments-and-incorporation-with-novel-scaffold-free-construct-technology
#4
Chase A Arbra, Satish N Nadig, Sarah Grace Dennis, Sanket Pattanaik, Heather A Bainbridge, J Matthew Rhett, Stephen A Fann, Carl Atkinson, Michael J Yost
Kidney transplantation is now a mainstream therapy for end-stage renal disease. However, with approximately 96,000 people on the waiting list and only one-fourth of these patients achieving transplantation, there is a dire need for alternatives for those with failing organs. In order to decrease the harmful consequences of dialysis along with the overall healthcare costs it incurs, active investigation is ongoing in search of alternative solutions to organ transplantation. Implantable tissue-engineered renal cellular constructs are one such feasible approach to replacing lost renal functionality...
March 27, 2018: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29644072/do-kidney-transplantations-save-money-a-study-using-a-before-after-design-and-multiple-register-based-data-from-sweden
#5
Johan Jarl, Peter Desatnik, Ulrika Peetz Hansson, Karl Göran Prütz, Ulf-G Gerdtham
Background: The health care costs of kidney transplantation and dialysis are generally unknown. This study estimates the Swedish health care costs of kidney transplantation and dialysis over 10 years from a health care perspective. Method: A before-after design was used, in which the patients served as their own controls. Health care costs the year before transplantation were assumed to continue in the absence of a transplant and the cost savings was therefore calculated as the difference between the expected costs and the actual costs during the 10-year follow-up period...
April 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29644070/intravenous-drug-users-who-require-dialysis-causes-of-renal-failure-and-outcomes
#6
Jemima K Scott, Dominic M Taylor, Chris R K Dudley
Background: Intravenous drug use is associated with progressive kidney disease of several aetiologies. It is associated with behavioural and lifestyle characteristics that make the provision of renal replacement therapies (RRTs) challenging. We observed that patients who use intravenous drugs [people who inject drugs (PWID)] present late to renal services and struggle to engage with treatment. We describe the experience of a UK centre providing renal services to a mixed city and rural population...
April 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29644065/frailty-and-chronic-kidney-disease-current-evidence-and-continuing-uncertainties
#7
Andrew C Nixon, Theodoros M Bampouras, Neil Pendleton, Alexander Woywodt, Sandip Mitra, Ajay Dhaygude
Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization...
April 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29624594/a-systematic-scoping-review-on-the-consequences-of-stress-related-hyperglycaemia
#8
Elena Olariu, Nicholas Pooley, Aurélie Danel, Montserrat Miret, Jean-Charles Preiser
BACKGROUND: Stress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed. METHODS: We conducted a systematic scoping review of observational studies following the Joanna Briggs methodology...
2018: PloS One
https://www.readbyqxmd.com/read/29619487/etiology-ethics-and-outcomes-of-chronic-kidney-disease-in-neonates
#9
Jameela A Kari, Sara N Sharief, Sherif M El Desoky, Khalid A Alhasan, Amr S Albanna
OBJECTIVES: To report the epidemiology of chronic kidney disease (CKD)  in neonates at a single tertiary center and the outcomes of renal replacement therapy (RRT) in these patients and discuss ethical considerations regarding RRT in this population. METHODS: In this retrospective study, we reviewed clinical data from all neonates with evidence of CKD who were followed up at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between 2005 and 2015. Follow-up serum creatinine levels were recorded every 6 months...
April 2018: Saudi Medical Journal
https://www.readbyqxmd.com/read/29617835/patient-and-transplant-outcome-in-infants-starting-renal-replacement-therapy-before-2-years-of-age
#10
Julien Hogan, Justine Bacchetta, Marina Charbit, Gwenaelle Roussey, Robert Novo, Michel Tsimaratos, Joelle Terzic, Tim Ulinski, Arnaud Garnier, Elodie Merieau, Jérôme Harambat, Isabelle Vrillon, Olivier Dunand, Denis Morin, Etienne Berard, Francois Nobili, Cécile Couchoud, Marie-Alice Macher
Background: Despite major technical improvements in the care of children requiring renal replacement therapy (RRT) before 2 years of age, the management of those patients remains challenging and transplantation is generally delayed until the child weighs 10 kg or is 2 years old. In this national cohort study, we studied patient and graft survival in children starting RRT before 2 years of age to help clinicians and parents when deciding on RRT initiation and transplantation management...
March 29, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29614569/-relationship-between-continuous-renal-replacement-therapy-and-hypophosphatemia-in-critically-ill-children
#11
T Sun, Y Q Ren, F Wang, H J Miao, Y J Shan, C X Wang, Y C Zhang
Objective: To investigate the incidence and prognosis of hypophosphatemia in critically ill children treated with continuous blood purification (CBP). Methods: The medical records of the critically ill patients, who were treated with CBP, admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2014 to April 2017 were retrospectively analyzed. The serum phosphorus levels were tested before CBP, at 48-72 h during CBP, at the end of CBP and on the next day after CBP finished. Phosphorus supplement was given to the children with severe hypophosphatemia...
April 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/29610664/hypomagnesemia-in-critically-ill-patients
#12
REVIEW
Bent-Are Hansen, Øyvind Bruserud
Background: Magnesium (Mg) is essential for life and plays a crucial role in several biochemical and physiological processes in the human body. Hypomagnesemia is common in all hospitalized patients, especially in critically ill patients with coexisting electrolyte abnormalities. Hypomagnesemia may cause severe and potential fatal complications if not timely diagnosed and properly treated, and associate with increased mortality. Main body: Mg deficiency in critically ill patients is mainly caused by gastrointestinal and/or renal disorders and may lead to secondary hypokalemia and hypocalcemia, and severe neuromuscular and cardiovascular clinical manifestations...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29605960/moderate-hypothermic-circulatory-arrest-%C3%A2-28%C3%A2-c-with-selective-antegrade-cerebral-perfusion-for-total-arch-replacement-with-frozen-elephant-trunk-technique
#13
Ali El-Sayed Ahmad, Petar Risteski, Mahmut Ay, Nestoras Papadopoulos, Anton Moritz, Andreas Zierer
OBJECTIVES:  The optimal hypothermic level during circulatory arrest in aortic arch surgery remains controversial, particularly in frozen elephant trunk (FET) procedures. We describe herein our experience for total arch replacement with FET technique under moderate systemic hypothermic circulatory arrest (≥ 28°C) during selective antegrade cerebral perfusion. METHODS:  Between January 2009 and January 2016, 38 consecutive patients underwent elective total arch replacement for various aortic arch pathologies with FET technique using the E-vita Open hybrid prosthesis (Jotec GmbH, Hechingen, Germany)...
April 1, 2018: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/29597227/from-continuous-renal-replacement-therapies-to-multiple-organ-support-therapy
#14
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco, Gaetano La Manna
The incidence of the multiple organ dysfunction syndrome (MODS) is rapidly increasing in intensive care units (ICU). It usually combines with sepsis and is the most frequent cause of death in the ICU patients. The nature of the ICU patients has changed in the last years. It includes a variety of patients with severe cases due to major surgical interventions, trauma, hemodynamic instability, sepsis, and so on but also older people than previous times. All these situations can easily lead to MODS. In the prior years, the only available and efficient therapy was renal replacement therapy (RRT) for treating acute renal failure, but the development of technology also gives us devices to support the other systems...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597224/ensuring-quality-of-care-through-monitoring-of-continuous-renal-replacement-therapies
#15
Mitchell H Rosner
The continuous renal replacement therapy (CRRT) has offered life-saving treatment for kidney failure. Technological advances coupled with findings from clinical trials have allowed for refinements both in the therapy and in the way it is applied to patients. However, outcomes for patients requiring CRRT remain suboptimal. The use of information technology coupled with structured quality improvement programs offers a methodology for studying the delivery of CRRT with an eye toward improving outcomes. Furthermore, integration of information from the CRRT treatment can be combined with real-time data from other patient-monitoring sources to create "feedback" loops where more timely changes in the CRRT prescription can occur...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597223/discontinuation-of-continuous-renal-replacement-therapy-and-dialysis-dependence
#16
Gregorio Romero-González, Anna Lorenzin, Mauro Neri, Fiorenza Ferrari, Alejandra Molano-Triviño, Alessandra Brendolan, Claudio Ronco
Renal replacement therapy (RRT) is a form of extracorporeal support for critical patients, especially for those with acute kidney injury. This therapy enables to gain adequate control over the great metabolic and fluids demand when kidneys are not able to do so; this condition is habitually present in patients who are admitted to intensive care units. However, it is also clear that these patients present a higher mortality rate and, in some cases, complications associated with the therapy. Therefore, it is fundamental to optimize and customize different aspects of RRT that range from the ideal timing including the modality and the dose until its suspension or ending...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597216/indications-and-timing-of-continuous-renal-replacement-therapy-application
#17
Sean M Bagshaw, Ron Wald
Renal replacement therapy (RRT) is increasingly utilized to support critically ill patients with severe acute kidney injury (AKI). The clinical dilemma of when to ideally start RRT in these patients has been a longstanding issue that is in need of higher quality evidence to guide clinical practice. When clinicians are confronted with patients with life-threatening complications of AKI, the decision to start RRT is straightforward. However, in the absence of clear indications, the ideal circumstances and timing that balance the perceived benefits and risks of early versus delayed RRT remain uncertain...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597215/evolution-of-vascular-access-and-anticoagulation
#18
Patrick M Honore, Herbert D Spapen
Continuous renal replacement therapy (CRRT) is an important and widely used adjuvant treatment in critically ill patients. However, any CRRT protocol can be adhered to only when the technique is correctly installed and functioning properly. Within this context, an appropriate vascular access and a safe and effective circuit anticoagulation method are key requisites. The right internal jugular (RIJ) vein is the preferred route for insertion with the tip of the catheter placed in the right atrium. Both femoral veins offer a valuable alternative access, but catheters must be longer to avoid recirculation and circuit blood flow is lower as compared with that of the RIJ approach...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597214/evolution-of-technology-for-continuous-renal-replacement-therapy-forty-years-of-improvement
#19
Claudio Ronco
Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29596073/the-development-of-a-machine-learning-inpatient-acute-kidney-injury-prediction-model
#20
Jay L Koyner, Kyle A Carey, Dana P Edelson, Matthew M Churpek
OBJECTIVES: To develop an acute kidney injury risk prediction model using electronic health record data for longitudinal use in hospitalized patients. DESIGN: Observational cohort study. SETTING: Tertiary, urban, academic medical center from November 2008 to January 2016. PATIENTS: All adult inpatients without pre-existing renal failure at admission, defined as first serum creatinine greater than or equal to 3.0 mg/dL, International Classification of Diseases, 9th Edition, code for chronic kidney disease stage 4 or higher or having received renal replacement therapy within 48 hours of first serum creatinine measurement...
March 28, 2018: Critical Care Medicine
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