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Renal Replacement Therapy in AKI

Chuan Zhou, Shichao Lai, Yong Xie, Shu Zhang, Yiping Lu
INTRODUCTION: Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with hypopituitarism, adrenal insufficiency and hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. CASE REPORT: We report the case of a 23-year-old male with primary hypopituitarism who developed acute renal impairment (AKI) with rhabdomyolysis after strenuous physical activity (push-ups)...
June 7, 2018: American Journal of Emergency Medicine
Joel Neugarten, Ladan Golestaneh, Nitin V Kolhe
BACKGROUND: Female sex has been included as a risk factor in models developed to predict the risk of acute kidney injury (AKI) associated with cardiac surgery, aminoglycoside nephrotoxicity and contrast-induced nephropathy. The commentary acompanying the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury concludes that female sex is a shared susceptibility factor for acute kidney injury based on observations that female sex is associated with the development of hospital-acquired acute kidney injury...
June 8, 2018: BMC Nephrology
F J Romeo, C F Varela, N Vulcano, R Pizarro, G Greloni, R Posatini, R Marenchino, G J Rosa-Diez, C A Belziti
BACKGROUND: Heart transplantation (HT) is regarded as the treatment of choice for end-stage heart failure (ESHF) patients. Severe acute kidney injury (AKI) after HT is a frequent clinical problem with devastating consequences for HT recipients. METHODS: Data from 112 ESHF patients undergoing HT in 2010-2015 were retrospectively reviewed. The primary end point was the development of AKI stage III, and secondary outcomes were in-hospital and 1-year mortality according to Kidney Disease Improving Global Outcomes criteria...
June 2018: Transplantation Proceedings
Susanne Stads, Louise Schilder, S Azam Nurmohamed, Frank H Bosch, Ilse M Purmer, Sylvia S den Boer, Cynthia G Kleppe, Marc G Vervloet, Albertus Beishuizen, Armand R J Girbes, Pieter M Ter Wee, Diederik Gommers, A B Johan Groeneveld, Heleen M Oudemans-van Straaten
INTRODUCTION: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality. The creatinine-based stage of AKI is considered when deciding to start or delay RRT. However, creatinine is not only determined by renal function (excretion), but also by dilution (fluid balance) and creatinine generation (muscle mass). The aim of this study was to explore whether fluid balance-adjusted creatinine at initiation of RRT is related to 28-day mortality independent of other markers of AKI, surrogates of muscle mass and severity of disease...
2018: PloS One
Chenglong Li, Hong Wang, Nan Liu, Ming Jia, Haitao Zhang, Xiuming Xi, Xiaotong Hou
BACKGROUND: Early fluid expansion could prevent postoperative organ hypoperfusion. However, excessive fluid resuscitation adversely influences multiple organ systems. This retrospective, observational study aimed to investigate the relationship between early negative fluid balance and postoperative mortality in critically ill adult patients following cardiovascular surgery. METHODS: In total, 567 critically ill patients who had undergone cardiovascular surgery and whose intensive care unit length of stay (LOS) was more than 24 hours were enrolled...
June 1, 2018: Perfusion
Marco Fiorentino, Fadi A Tohme, Shu Wang, Raghavan Murugan, Derek C Angus, John A Kellum
BACKGROUND: Several studies have shown that long-term survival after acute kidney injury (AKI) is reduced even if there is clinical recovery. However, we recently reported that in septic shock patients those that recover from AKI have survival similar to patients without AKI. Here, we studied a cohort with less severe sepsis to examine the effects of AKI on longer-term survival as a function of recovery by discharge. METHODS: We analyzed patients with community-acquired pneumonia from the Genetic and Inflammatory Markers of Sepsis (GenIMS) cohort...
2018: PloS One
Amna Hamid, Murtaza F Dhrolia, Ruqayya Qureshi, Salman Imtiaz, Aasim Ahmad
Chikungunya fever is an arthropod-borne viral illness characterised by high grade fever and incapacitating arthralgias. It is considered benign; however, in the recent outbreaks, several complications have been reported worldwide. We report a case of male patient with Chikungunya fever, possibly contracted from infected mosquitoes endemic in Karachi, Pakistan. The clinical presentation included fever, myalgias and anuria. Investigations revealed renal failure and significantly raised creatinine phosphokinase (CPK), suggesting rhabdomyolysis to be the cause of acute kidney injury (AKI)...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
K Mehta, A Pajai, S Bhurke, A Shirkande, R Bhadade, R D'Souza
The epidemiological pattern of acute kidney injury (AKI) in tropical countries during monsoon reflects infectious disease as the most important cause. AKI is a confounding factor and may be overlooked by primary health-care providers and underreported in health statistics. The present study prospectively helps estimate the burden of disease and analyze etiology, clinical profile, and outcome in a tertiary care hospital of a metropolitan city in a tropical country. The study period included monsoon season of 2012 and 2013, a total of 8 months...
March 2018: Indian Journal of Nephrology
W L Jabur, P Nasa, K A Mohammed, A Kulkarni, S N Tomaraei
Exercise-induced rhabdomyolysis (EIR) is an uncommon cause of severe rhabdomyolysis and a very rare cause of acute kidney injury (AKI). A prospective observational study of 25 patients diagnosed with EIR was conducted in a multispecialty hospital in Dubai, from 2009 to 2015. Five out of 25 patients experienced AKI necessitating temporary renal replacement therapy. The initial presentation, biochemical parameters, and clinical course of patients were monitored, to understand epidemiology and risk factors for the development of AKI...
March 2018: Indian Journal of Nephrology
Natacha Riffaut, Olivier Moranne, Alexandre Hertig, Thierry Hannedouche, Cécile Couchoud
Background: Acute kidney injury (AKI) is a common condition that is associated with poor short- and long-term outcomes. The aim of this nationwide cohort study was to profile the long-term outcome of patients admitted for AKI in France. Methods: Based on the comprehensive French hospital discharge database, all hospitalizations for an AKI episode were categorized in four groups according to the presence of at least one dialysis session [renal replacement therapy (RRT)] and according to the coding of AKI as the principal or associated diagnosis (PRINC_DIAG or ASS_DIAG)...
May 26, 2018: Nephrology, Dialysis, Transplantation
Adeola Okoduwa, Nabeela Ahmed, Yi Guo, Marco R Scipione, John Papadopoulos, Daniel P Eiras, Yanina Dubrovskaya
Nephrotoxicity is a known adverse effect of polymyxin B (PMB). Animal data suggests that once daily dosing may reduce the rate and delay the onset of acute kidney injury (AKI).In a multicenter, retrospective study, we evaluated adult patients with a creatinine clearance (CrCl) ≥30 mL/min who received ≥48h of PMB therapy. The primary endpoint was the difference in rate of AKI comparing once and twice daily PMB dosing. Secondary endpoints included time to AKI and recovery of renal function.Of 273 eligible patients, 100 from each group were matched based on propensity scores...
May 29, 2018: Antimicrobial Agents and Chemotherapy
Faizia Naseem, Abid Hussain, Fehmina Arif
Background and Objective: Tetanus is a potentially fatal but preventable disease. Mortality is related to severity of the disease, cardiovascular, pulmonary and renal complications. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus. The objective was to determine the frequency of AKI in tetanus patients managed in a public hospital. Methods: Children aged 1-12 years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over three and half years were recruited for the retrospective study...
March 2018: Pakistan Journal of Medical Sciences Quarterly
Valentina Pistolesi, Giuseppe Regolisti, Santo Morabito, Ilaria Gandolfini, Silvia Corrado, Giovanni Piotti, Enrico Fiaccadori
BACKGROUND AND AIMS: Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of hospital-acquired acute kidney injury. It is more commonly observed following intra-arterial administration of iodinated contrast media (CM) for cardiac procedures in patients with pre-existing chronic kidney disease (CKD), and is associated with increased short- and long-term morbidity and mortality. This review investigates the key current evidence on CI-AKI definition, epidemiology and pathogenesis, as a basis for recommending preventive measures that can be implemented in clinical practice...
May 25, 2018: Journal of Nephrology
Chih-Chin Kao, Wei-Shun Yang, Ji-Tseng Fang, Kathleen D Liu, Vin-Cent Wu
Despite supportive care with renal replacement therapy, acute kidney injury (AKI) remains linked with increased short and long-term mortality, not just because of renal failure but also because of accompanying remote organ dysfunction. Increasing evidence from animal studies suggests that numerous factors contribute both to the development of AKI and the impairment of various vital organs, including pro-inflammatory cytokine expression, leukocyte infiltration, vascular permeability changes, ion channel derangement, oxidative stress, and cell apoptosis...
May 21, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Y P Zhou, J Y Shi, F Wang, Y Cui, T T Xu, C X Wang, Y C Zhang
Objective: To explore the effectiveness and safety of continuous renal replacement therapy (CRRT) combined with extracorporeal membrane oxygenation (ECMO) on rescuing pediatric patients with cardiopulmonary failure. Methods: The medical records of patients treated with ECMO admitted to pediatric intensive care unit (PICU) in Shanghai Children's Hospital from December 2015 to November 2017 were retrospectively extracted. There were 14 patients treated with ECMO combined with CRRT (ECMO+ CRRT group) due to acute kidney injury (AKI) or fluid overload, while 11 cases treated with ECMO only...
May 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Grace Igiraneza, Benedicte Ndayishimiye, Menelas Nkeshimana, Vincent Dusabejambo, Onyema Ogbuagu
Introduction: Acute kidney injury (AKI) requiring renal replacement therapy is associated with high mortality. The study assessed the impact of the introduction of hemodialysis (HD) on outcomes of patients with AKI in Rwanda. Methods: A single center retrospective study that evaluated the clinical profile and survival outcomes of patients with AKI requiring HD [AKI-D] at a tertiary hospital in Rwanda. Data was collected on patients who received HD for AKI from September 2014 to December 2016...
2018: BioMed Research International
Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand
PURPOSE: Acute kidney injury (AKI) is associated with the activation of the renin-angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI. METHODS: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort...
May 15, 2018: Intensive Care Medicine
Sidharth K Sethi, Veena Raghunathan, Shilpi Shah, Maninder Dhaliwal, Pranaw Jha, Maneesh Kumar, Sravanthi Paluri, Shyam Bansal, Maroun J Mhanna, Rupesh Raina
Objectives: We investigated the association of fluid overload and oxygenation in critically sick children, and their correlation with various outcomes (duration of ventilation, ICU stay, and mortality). We also assessed whether renal angina index (RAI) at admission can predict mortality or acute kidney injury (AKI) on day 3 after admission. Design and setting: Prospective study, pediatric intensive care in a tertiary hospital. Duration: June 2013-June 2014. Patients: Patients were included if they needed invasive mechanical ventilation for >24 h and had an indwelling arterial catheter...
2018: Frontiers in Pediatrics
Chad Gorbatkin, John Bass, Fredric O Finkelstein, Steven M Gorbatkin
Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD...
May 2018: Western Journal of Emergency Medicine
Mohammed Azar, Abdulrahman Alamir, Abdullah Thabet Al Qahtani, Al Mokali Khamisa, Khalid Alfakeeh
Extracorporeal membrane oxygenation (ECMO) is considered a recognized lifesaving support for patients with cardiorespiratory failure. Acute kidney injury (AKI) and fluid overload are significant morbidity factors resulting in serious complications. The inline hemofilter system (IHS) and the continuous renal replacement therapy (CRRT) machine are different methods of renal replacement therapy for patients with ECMO. IHS is the alternate, safe dialysis modality of choice because it is user-friendly, inexpensive, and efficiently removes fluid overload and renal diffusive clearance...
2018: Therapeutics and Clinical Risk Management
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