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RENAL REPLACEMENT THERAPIES

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https://www.readbyqxmd.com/read/29684618/everolimus-is-a-new-anti-cancer-molecule-metabolic-side-effects-as-lipid-disorders-and-hyperglycemia
#1
REVIEW
L Morviducci, F Rota, L Rizza, P Di Giacinto, S Ramponi, M R Nardone, C Tubili, A Lenzi, P Zuppi, R Baldelli
In the last few years, molecular targeted therapies have replaced traditional cytotoxic chemotherapy in the fight against many cancers to the extent that our understanding of tumor biology has become more sophisticated. This shift has markedly changed adverse event profiles, compared to cytotoxic chemotherapy, affecting a diverse range of organ systems. Everolimus was approved by the FDA in 2011 for the treatment of progressive pancreatic NE tumors (Yao, 2011; Jensenn, 2012). It is an inhibitor of mammalian target of rapamycin (mTOR) and exhibits antitumor activity via disruption of various signaling pathways and it's used in the treatment of advanced renal cell cancer, breast cancer and neuroendocrine tumors (NET); it's used also as anti-rejection agent for transplantation but with lower doses for anti-rejection (1...
April 20, 2018: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29684185/factors-associating-with-differences-in-the-incidence-of-renal-replacement-therapy-among-elderly-data-from-the-era-edta-registry
#2
Jaakko Helve, Anneke Kramer, Jose M Abad-Diez, Cecile Couchoud, Gabriel de Arriba, Johan de Meester, Marie Evans, Florence Glaudet, Carola Grönhagen-Riska, James G Heaf, Visnja Lezaic, Maurizio Nordio, Runolfur Palsson, Ülle Pechter, Halima Resic, Rafael Santamaria, Carmen Santiuste de Pablos, Ziad A Massy, Óscar Zurriaga, Kitty J Jager, Patrik Finne
Background: The incidence of renal replacement therapy (RRT) in the general population ≥75 years of age varies considerably between countries and regions in Europe. Our aim was to study characteristics and survival of elderly RRT patients and to find explanations for differences in RRT incidence. Methods: Patients ≥75 years of age at the onset of RRT in 2010-2013 from 29 national or regional registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry were included...
April 18, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29683075/ex-vivo-repair-of-a-renal-artery-saccular-aneurysm-in-a-living-nonrelated-donor-and-subsequent-successful-kidney-transplantation
#3
Rogerio A Muñoz-Vigna, Javier E Anaya-Ayala, Juan N Ramirez-Robles, Daniel Nuño-Diaz, Sandra Olivares-Cruz
The use of kidney grafts with aneurysmal disease involving the renal arteries for transplantation is very uncommon and relatively controversial. We herein present the case of a 52-year-old woman who volunteered to become a living-nonrelated donor; during the preoperative imaging workup, a computed tomography angiography revealed a 1.5-cm saccular aneurysm in the left kidney, while the contralateral renal artery was normal. We decided to utilize the left kidney for a 25-year-old male patient with end-stage renal disease, and following the ex vivo repair using the recipient epigastric vessels and saphenous veins, we completed the transplantation in the right pelvic fossa...
January 1, 2018: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29682748/successful-practice-transitioning-between-hemodialysis-and-hemodiafiltration-in-outpatient-units-ten-key-issues-for-physicians-to-remember
#4
Tibor Fülöp, Mihály B Tapolyai, Lajos Zsom, Miklos Z Molnar, Sohail Abdul Salim, László Újhelyi, Gergely Becs, József Balla, Mehrdad Hamrahian
Hemodiafiltration (HDF) during chronic renal replacement therapy (RRT) is a relatively new practice phenomenon, emerging over the last two decades. While the technological platforms utilized during chronic RRT are in many cases similar or effectively identical to conventional hemodialysis (HD), significant differences may emerge in daily practice. Several authors of this review moved practice site between the United States and the European Union and transitioned from an HD-based practice to predominantly HDF-practicing networks...
April 22, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29681959/levosimendan-in-patients-with-low-ejection-fraction-undergoing-cardiac-surgery
#5
Ewa M Kucewicz-Czech, Tomasz Maciejewski, Barbara Budziarz, Tadeusz Kołodziej, Kazimierz Kiermasz, Leszek Machej
Introduction: Significant impairment of left ventricular function causes low cardiac output syndrome in the immediate postoperative period in 3-14% of patients undergoing surgery, increasing the mortality 15-fold. Aim: To assess the use of levosimendan in patients undergoing cardiac surgery in 2016. Material and methods: The analysis included 14 patients: 3 (21.4%) women and 11 (78.6%) men aged 65.4 ±11.8 years. The mean value of left ventricular ejection fraction amounted to 20 ±6...
March 2018: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/29680873/pediatric-nephrolithiasis-a-systematic-approach-from-diagnosis-to-treatment
#6
REVIEW
Giuseppina Marra, Francesca Taroni, Alfredo Berrettini, Emanuele Montanari, Gianantonio Manzoni, Giovanni Montini
Nephrolithiasis is a rare disease in children. For many years children with kidney stones have been managed like "small adults", but there are significant differences between the pediatric and the adult age in clinical presentation, etiology and treatment. Management of this condition in children has some peculiarities with respect to the adult, as it is often the sign of an underlying metabolic abnormality. Some of these metabolic alterations can lead to serious consequences, such as chronic renal failure, if not adequately diagnosed and treated...
April 21, 2018: Journal of Nephrology
https://www.readbyqxmd.com/read/29680020/uncovering-real-mortality-trends-in-esrd-patients
#7
Bénédicte Stengel
Major temporal changes in the case mix of patients accepted for renal replacement therapy impede analysis of long-term mortality trends in end-stage renal disease patients. A record linkage study of 2 large electronic hospital inpatient data sets with national mortality data used standardization by age, sex, and comorbidity to uncover a 50% decline in 3-year mortality in English patients starting renal replacement therapy between 1970 and 2008, a faster drop than that seen in the general population.
May 2018: Kidney International
https://www.readbyqxmd.com/read/29676703/effect-of-intraoperative-single-shot-application-of-vancomycin-in-liver-transplant-recipients-on-postoperative-infections-with-enterococcus-faecium-and-enterococcus-faecalis
#8
Christian Siebers, Johannes Kinzinger, Ludwig C Hinske, Andreas Bauer, Patrick Scheiermann, Michael Zoller, Markus Guba, Martin Angele, Sebastian Pratschke, Thomas Weig
OBJECTIVES: Infections are major causes of morbidity and mortality in the early postoperative period after liver transplant. We observed a high rate of enterococcal infections at our center. Therefore, we added an intraoperative single shot of vancomycin to the standard regimen of meropenem given over 5 days. The aim of this study was to determine the prevalence of both Enterococcus faecium and Enterococcus faecalis infections during the first 28 days after surgery depending on the type of antibiotic prophylaxis and their implications on mortality and morbidity...
April 20, 2018: Experimental and Clinical Transplantation
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
#9
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/29672685/surgical-and-early-outcomes-for-type-a-aortic-dissection-with-preoperative-renal-dysfunction-stratified-by-estimated-glomerular-filtration-rate
#10
Tianyu Zhou, Jun Li, Yongxin Sun, Jiawei Gu, Kai Zhu, Yulin Wang, Hao Lai, Chunsheng Wang
OBJECTIVES: The aim of this study was to analyse the effect of preoperative renal dysfunction on surgical and early outcomes for patients with Type A aortic dissection (AAD). METHODS: From January 2016 to December 2016, 140 patients with AAD who underwent surgical treatment at our institution were retrospectively analysed. According to the estimated glomerular filtration rate (eGFR), preoperative renal dysfunction was divided into 4 groups: normal (eGFR ≥90 ml/min/1...
April 17, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29672418/perioperative-use-of-levosimendan-improves-clinical-outcomes-in-patients-post-cardiac-surgery-a-systematic-review-and-meta-analysis
#11
Hua Qiang, Xiu Luo, Jian-Hua Huo, Zhi-Quan Wang
Severe postoperative complications can affect cardiac surgery patients. Levosimendan is a novel calcium sensitizer commonly administered after cardiac surgery. However, the patient benefits are controversial. PubMed, Embase, and the Cochrane library were systematically searched for randomized controlled trials (RCTs) comparing levosimendan with control in adult cardiac surgery patients. Twenty-five studies (3247 patients) were included. Pooled data indicated that levosimendan reduced mortality after cardiac surgery (OR 0...
April 3, 2018: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/29672307/extended-sessions-of-polymyxin-b-immobilized-fiber-column-hemoperfusion-ameliorate-renal-outcome-and-mortality-in-septic-shock-with-acute-kidney-injury
#12
Hiroshi Maekawa, Kousuke Negishi
BACKGROUND/AIMS: Polymyxin-B (PMX) treatment has been reported to decrease mortality in patients with septic shock and acute kidney injury (AKI). In this study, we aimed to evaluate whether extended sessions of PMX (Ext-PMX) immobilized fiber column hemoperfusion ameliorate clinical outcomes in patients complicated with septic shock and AKI without surgical control. METHODS: Twenty-two patients with nonsurgical septic shock and AKI who received PMX were included...
April 19, 2018: Blood Purification
https://www.readbyqxmd.com/read/29671865/diabetes-and-necrotizing-soft-tissue-infections-a-prospective-observational-cohort-study-statistical-analysis-plan
#13
A Rosén, P Arnell, M B Madsen, B G Nedrebø, A Norrby-Teglund, O Hyldegaard, V M Dos Santos, F Bergey, E Saccenti, S Skrede
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used. METHODS: Within the framework of INFECT project, patients with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study...
April 19, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29671040/preoperative-right-heart-hemodynamics-predict-postoperative-acute-kidney-injury-after-heart-transplantation
#14
Goksel Guven, Milos Brankovic, Alina A Constantinescu, Jasper J Brugts, Dennis A Hesselink, Sakir Akin, Ard Struijs, Ozcan Birim, Can Ince, Olivier C Manintveld, Kadir Caliskan
PURPOSE: Acute kidney injury (AKI) frequently occurs after heart transplantation (HTx), but its relation to preoperative right heart hemodynamic (RHH) parameters remains unknown. Therefore, we aimed to determine their predictive properties for postoperative AKI severity within 30 days after HTx. METHODS: From 1984 to 2016, all consecutive HTx recipients (n = 595) in our tertiary referral center were included and analyzed for the occurrence of postoperative AKI staged by the kidney disease improving global outcome criteria...
April 18, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29671035/-prognostic-relevance-of-tissue-oxygen-saturation-in-patients-in-the-early-stage-of-multiple-organ-dysfunction-syndrome
#15
D Huster, F Härtel, S Nuding, J Schroeder, Y Zhang, K Werdan, H Ebelt
BACKGROUND: Patients in circulatory shock exhibit insufficient peripheral perfusion to ensure adequate oxygenation of vital organs such as the heart and brain. Early detection of reduced tissue oxygen saturation (St O2 ) could be used for rapid therapeutic intervention and thus improve the prognosis of patients in the early stage of multiple organ dysfunction syndrome (MODS). MATERIALS AND METHODS: A total of 60 patients in the early stage of MODS (APACHE [Acute Physiology and Chronic Health Evaluation] II score ≥20) were investigated in a monocentric, prospective, randomized phase II study...
April 18, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29670870/adjunctive-therapies-during-extracorporeal-membrane-oxygenation-to-enhance-multiple-organ-support-in-critically-ill-children
#16
REVIEW
Marguerite Orsi Canter, Jessica Daniels, Brian C Bridges
Since the advent of extracorporeal membrane oxygenation (ECMO) over 40 years ago, there has been increasing interest in the use of the extracorporeal circuit as a platform for providing multiple organ support. In this review, we will examine the evidence for the use of continuous renal replacement therapy, therapeutic plasma exchange, leukopheresis, adsorptive therapies, and extracorporeal liver support in conjunction with ECMO.
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29669237/current-practice-of-diagnosis-and-management-of-acute-kidney-injury-in-intensive-care-unit-in-resource-limited-settings
#17
Nattachai Srisawat, Nattaya Sintawichai, Win Kulvichit, Nuttha Lumlertgul, Patita Sitticharoenchai, Nicha Thamrongsat, Sadudee Peerapornratana
PURPOSE: In a resource limited settings, there is sparse information about the management of acute kidney injury (AKI) based on systemic data collection. This survey aimed to described the current management of AKI in intensive care units (ICUs) across Thailand. MATERIALS AND METHODS: Questionnaires were distributed to 160 physicians involved in the intensive care between January and December 2014 across Thailand. Distribution was done through an online survey platform or telephone interview...
April 11, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29665838/fungal-infections-in-adult-patients-on-extracorporeal-life-support
#18
Yiorgos Alexandros Cavayas, Hakeem Yusuff, Richard Porter
BACKGROUND: Patients on extracorporeal membrane oxygenation (ECMO) are often among the most severely ill in the intensive care unit. They are often receiving broad-spectrum antibiotics; they have multiple entry points for pathogens; and their immune system is impaired by blood circuit interaction. These factors are thought to predispose them to fungal infections. We thus aimed to evaluate the prevalence, risk factors, and prognosis of fungal infections in adults on ECMO. METHODS: We conducted a retrospective cohort study using the Extracorporeal Life Support Organization registry, which compiles data on ECMO use from hundreds of international centers...
April 17, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29665203/tolvaptan-alleviates-excessive-fluid-retention-of-nephrotic-diabetic-renal-failure-unresponsive-to-furosemide
#19
Tesshu Takada, Tsuguto Masaki, Ayako Hoshiyama, Takuya Toki, Yuji Kamata, Masayoshi Shichiri
Patients with diabetic nephropathy develop nephrotic syndrome, and may show limited response to conventional therapy. They often require earlier initiation of renal replacement therapy because they become refractory to diuretics, and experience excessive fluid retention. We aimed to investigate the efficacy of tolvaptan, an oral arginine vasopressin type 2 receptor antagonist, in a case series of 14 severe diabetic renal failure patients who were severely refractory to maximal doses of furosemide and had excessive fluid retention despite preserved cardiac function and residual renal function...
April 17, 2018: Nephrology
https://www.readbyqxmd.com/read/29664506/continuous-venovenous-hemofiltration-in-neonates-with-hyperammonemia-a-case-series
#20
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
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