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Gabor Erdoes, Dominik E Uehlinger, Beatrice Kobel, Monika P Stucki, Roland Wiest, Frank Stueber, Niklaus Fankhauser, Stephan M Jakob, Joerg C Schefold
BACKGROUND: Microembolism is a frequent pathological event during extracorporeal renal replacement therapy (RRT). Some previous data indicate that microemboli are generated in patients who are undergoing RRT and that these may contribute to increased cerebrovascular and neurocognitive morbidity in patients with end-stage renal disease. The current trial aims to quantify the microembolic load and respective qualitative composition that effectively reaches the intracerebral circulation in critically ill patients treated with different RRT modalities for acute kidney injury (AKI)...
March 21, 2018: Trials
Filipe S Cardoso, Michelle Gottfried, Shannan Tujios, Jody C Olson, Constantine J Karvellas
Hyperammonemia has been associated with intracranial hypertension and mortality in patients with acute liver failure (ALF). We evaluated the effect of renal replacement therapy (RRT) on serum ammonia level and outcomes in ALF. This was a multicenter cohort study of consecutive ALF patients from the United States ALF Study Group registry between January 1998 and December 2016. First, we studied the association of ammonia with hepatic encephalopathy (HE) and 21-day transplant-free survival (TFS; n = 1,186). Second, we studied the effect of RRT on ammonia for the first 3 days post study admission (n = 340) and on 21-day TFS (n = 1,186)...
August 31, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Tonio Schoenfelder, Xiaoyu Chen, Hans-Holger Bleß
Background: Dialysis-dependent acute kidney injury (AKI) can be treated using continuous (CRRT) or intermittent renal replacement therapies (IRRT). Although some studies suggest that CRRT may have advantages over IRRT, study findings are inconsistent. This study assessed differences between CRRT and IRRT regarding important clinical outcomes (such as mortality and renal recovery) and cost-effectiveness. Additionally, ethical aspects that are linked to renal replacement therapies in the intensive care setting are considered...
2017: GMS Health Technology Assessment
Carla Silva-Batista, Daniel Montie Corcos, Renato Barroso, Fabian J David, Hélcio Kanegusuku, Cláudia Forjaz, Marco Túlio DE Mello, Hamilton Roschel, Valmor Tricoli, Carlos Ugrinowitsch
PURPOSE: This study compared the effects of resistance training (RT) and RT with instability (RTI) on neuromuscular and total training volume (TTV) outcomes obtained as part of the Instability Resistance Training Trial in Parkinson's disease. It also used a linear multiple regression (forward stepwise method) to identify the contribution of neuromuscular outcomes to previously published improvements in the timed-up-and-go test and the Unified Parkinson's Disease Rating Scale, motor subscale score...
April 2017: Medicine and Science in Sports and Exercise
Christina Alliger-Horn, Peter Lutz Zimmermann, Mervyn Schmucker
BACKGROUND: The consideration of specific trauma-associated emotions poses a challenge for the differential treatment planning in trauma therapy. Soldiers experiencing deployment-related posttraumatic stress disorder often struggle with emotions of guilt and shame as a central component of their PTSD. OBJECTIVE: The purpose of this study was to examine the extent to which soldiers' PTSD symptoms and their trauma-related guilt and shame may be affected as a function of their ability to develop compassionate imagery between their CURRENT SELF (today) and their TRAUMATIZED SELF (back then)...
October 20, 2016: Journal of Clinical Medicine
Kianoush Kashani, Ravindra L Mehta
From the initial version of an extended renal replacement therapy, the initiative to provide safer, more efficient means for detoxification and volume removal in comparison with intermittent renal replacement therapies (IRRT) has been evaluated. As a result, the Kidney Disease Improving Global Outcomes guidelines for acute kidney injury recommend the preferential use of continuous renal replacement therapy (CRRT) in patients who are hemodynamically unstable or who suffer from intracranial hypertension. The choice of dialysis modality is also influenced by other factors including clinical expertise, and the availability of each treatment option in individual medical centers...
July 2016: Seminars in Dialysis
Kayvan Bozorgmehr, Oliver Razum
BACKGROUND: Access to health care for asylum-seekers and refugees (AS&R) in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a) restricted access; and (b) two major policy reforms (1997, 2007) on incident health expenditures for AS&R in 1994-2013. METHODS AND FINDINGS: We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013) to compare incident health expenditures among AS&R with restricted access (exposed) to AS&R with regular access (unexposed)...
2015: PloS One
Zhiping Sun, Fuxi Sun, Changming Niu, Xia Shen, Hong Ye, Hongdi Cao
OBJECTIVE: To investigate the influence of fluid balance and model of renal replacement therapy (RRT) on renal function and prognosis of patients suffering from septic acute kidney injury (AKI). METHODS: A retrospective cohort analysis of 117 septic AKI patients who had undergone RRT between January 2009 and December 2014 was performed in the Second Affiliated Hospital of Nanjing Medical University. The patients were divided into positive fluid balance group (n = 52) and negative fluid balance group (n = 65) according to the total amount of fluid calculated from the difference between fluid administered and fluid lost during the first 1 week of RRT...
May 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Atsuo Nakamura, Osamu Takasu, Yoshiro Sakai, Teruo Sakamoto, Norio Yamashita, Shinjiro Mori, Toshio Morita, Masakazu Nabeta, Nobuhisa Hirayu, Naomasa Yoshiyama, Mariko Moroki, Keita Tashiro, Mikinori Kannae
We performed high-dose loading (12 mg/kg every 12 h for 48 h; 4 doses total) of teicoplanin (TEIC) in patients with severe methicillin-resistant Staphylococcus aureus (MRSA) infections, with the goal of achieving target serum concentration (TEICc) ≥ 15 mg/l within 48 h of starting administration. The safety and effectiveness of the fixed, early-stage administration method were evaluated across a range of kidney dysfunction severity levels. TEIC high-dose loading was administered to 106 patients with MRSA infection from February 2010 to February 2013...
June 2015: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Masao Iwagami, Hideo Yasunaga, Eisei Noiri, Hiromasa Horiguchi, Kiyohide Fushimi, Takehiro Matsubara, Naoki Yahagi, Masaomi Nangaku, Kent Doi
PURPOSE: This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs). MATERIALS AND METHODS: Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. We identified adult patients without end-stage renal disease who had been admitted to ICUs for 3 days or longer and started continuous RRT (CRRT) or intermittent RRT (IRRT). Logistic regression was used to analyze which factors affected the modality choice...
April 2015: Journal of Critical Care
Olivier Ethgen, Antoine G Schneider, Sean M Bagshaw, Rinaldo Bellomo, John A Kellum
BACKGROUND: The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU). METHODS: Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients...
January 2015: Nephrology, Dialysis, Transplantation
Lin Lin, Hui Yan, Jian Xiao, Yingfang Ao, Guoqing Cui
PURPOSE: A new clinical test for evaluating subscapularis (SSC) integrity was described, and its diagnostic value was compared with the present SSC tests (the lift-off, belly-press, IRLS and bear-hug tests). The new test is called internal rotation resistance test at abduction and external rotation (IRRT). The test is performed at maximal 90° of abduction and maximal external rotation. METHODS: Two hundred and thirty-five consecutive patients suffering from rotator cuff injury were evaluated preoperatively...
April 2015: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Marko Caćić
Acute kidney injury (AKI) is the sudden kidney excretory function loss. Patient data of patients hospitalized on intensive care unit from 2009 to 2011 and had to undergo one sort of renal replacement therapy (RRT)--continuous or intermittent--was used. 63 patients were in this study, 46 on continuous RRT (CRRT) and 17 on intermittent RRT (IRRT). The aim was to analyze connection between RRT method and outcome, DM type 2 and outcome, malignant disease and outcome, to analyze whether there is statistically significant difference between these and other parameters (potassium, urea, creatinine, blood pressure, age, and sex)...
January 2013: Lijec̆nic̆ki Vjesnik
Antoine G Schneider, Rinaldo Bellomo, Sean M Bagshaw, Neil J Glassford, Serigne Lo, Min Jun, Alan Cass, Martin Gallagher
PURPOSE: Choice of renal replacement therapy (RRT) modality may affect renal recovery after acute kidney injury (AKI). We sought to compare the rate of dialysis dependence among severe AKI survivors according to the choice of initial renal replacement therapy (RRT) modality applied [continuous (CRRT) or intermittent (IRRT)]. METHODS: Systematic searches of peer-reviewed publications in MEDLINE and EMBASE were performed (last update July 2012). All studies published after 2000 reporting dialysis dependence among survivors from severe AKI requiring RRT were included...
June 2013: Intensive Care Medicine
Delphine M De Smedt, Monique M Elseviers, Robert L Lins, Lieven Annemans
BACKGROUND: Major controversy exists regarding the preferred treatment option for acute kidney injury (AKI). The purpose of this study was to assess the incremental cost-effectiveness of continuous renal replacement therapy (CRRT) versus intermittent renal replacement therapy (IRRT) and conservative (CONS) AKI treatment in Belgium. METHODS: An area-under-the-curve model based on survival analysis was used to estimate costs and health outcomes using a 2-year time horizon...
November 2012: Nephrology, Dialysis, Transplantation
Raymond Vanholder, Wim Van Biesen, Eric Hoste, Norbert Lameire
The question of whether renal replacement therapy should be applied in an intermittent or continuous mode to the patient with acute kidney injury has been the topic of several controlled studies and meta-analyses. Although continuous renal replacement therapy (CRRT) has a theoretical advantage due to offering the opportunity to remove excess fluid more gradually, none of the several outcome studies that have been undertaken in the meanwhile was able to demonstrate its superiority over intermittent renal replacement therapy (IRRT)...
January 28, 2011: Critical Care: the Official Journal of the Critical Care Forum
Belinda A Campbell, Nick Voss, Ryan Woods, Randy D Gascoyne, James Morris, Tom Pickles, Joseph M Connors, Kerry J Savage
BACKGROUND: Given the indolent behavior of follicular lymphoma (FL), it is controversial whether limited stage FL can be cured using radiotherapy (RT). Furthermore, the optimal RT field size is unclear. The authors of this report investigated the long-term outcomes of patients with limited stage FL who received RT alone and studied the impact of reducing the RT field size from involved regional RT (IRRT) to involved node RT with margins up to 5 cm (INRT<or=5 cm). METHODS: Eligible patients had limited stage, grade 1 through 3A FL diagnosed between 1986 and 2006 and treated were with curative-intent RT alone...
August 15, 2010: Cancer
Shigehiko Uchino
Acute kidney injury (AKI) is a common complication among critical illnesses. In severe cases, renal replacement therapy (RRT) is required. It has been reported that hospital mortality of the patients who require RRT is more than 60%. Because of the high mortality, it is quite important to conduct RRT appropriately to improve outcome of patients with severe AKI. However, RRT is not a single homogeneous therapy but rather there are diverse modes of therapy and various ways of providing RRT that might affect its efficacy and safety...
2010: Contributions to Nephrology
Nattachai Srisawat, Loredo Lawsin, Shigehiko Uchino, Rinaldo Bellomo, John A Kellum
INTRODUCTION: Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other, and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites, and, to date, only single-center cost studies have been performed...
2010: Critical Care: the Official Journal of the Critical Care Forum
Sylvain Vidal, Philippe Richebé, Laurent Barandon, Joachim Calderon, Nadir Tafer, Olivier Pouquet, Nelly Fournet, Gérard Janvier
BACKGROUND: Cardiogenic dysfunction with acute renal failure (ARF) and diuretic drug resistance increases mortality after cardiac surgery with cardiopulmonary bypass (CPB) in adults. Until few years ago, intermittent renal replacement therapy (IRRT) was the only therapeutical strategy proposed to such patients. Few data are available in the literature regarding the use of continuous veno-venous haemofiltration (CVVH) in this clinical context. The aim of our observational study was to evaluate the impact of CVVH strategy on ARF in conjunction with cardiogenic shock after cardiac surgery and on its well-known associated poor outcome...
September 2009: European Journal of Cardio-thoracic Surgery
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