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Critical Care Nephrology

Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
Aline C Q Leão, Paulo R Menezes, Maura S Oliveira, Anna S Levin
BACKGROUND: It has been challenging to determine the true clinical impact of Acinetobacter spp., due to the predilection of this pathogen to colonize and infect critically ill patients, who often have a poor prognosis. The aim of this study was to assess whether Acinetobacter spp. bacteremia is associated with lower survival compared with bacteremia caused by other pathogens in critically ill patients. METHODS: This study was performed at Hospital das Clínicas, University of São Paulo, Brazil...
2016: BMC Infectious Diseases
Kathryn D Winters, Stephanie Toth-Manikowski, Carol Martire, Tariq Shafi
BACKGROUND: Correctly assessing and managing volume status are critical elements of daily care for patients managed by nephrologists. However, intravascular volume is difficult to assess by physical examination alone. METHODS: We present vignettes illustrating the potential for using hand-carried ultrasound (HCU) to improve volume assessment in common clinical scenarios faced by the renal consultant in the hospital setting. These include patients with acute kidney injury and patients treated with hemodialysis...
July 2016: Medicine (Baltimore)
Julius Okel, Ike G Okpechi, Bilal Qarni, Timothy Olanrewaju, Mark J Courtney, Valerie Luyckx, Sarala Naicker, Aminu K Bello
An effective workforce is essential for delivery of high-quality chronic disease care. Low-income nations are challenged by a dearth and/or maldistribution of an essential workforce required for all chronic disease care including chronic kidney disease (CKD). Nephrology education and training in developed countries have grown at pace with the technological advancement in the practice of medicine in order to meet the standards required of kidney health professionals towards high-quality, patient-centered medical care...
July 29, 2016: Clinical Nephrology
Norbert Lameire, Wim Van Biesen, Raymond Vanholder
In this review we summarize the world-wide epidemiology of acute kidney injury (AKI) in children with special emphasis on low-income countries, notably those of the sub-Saharan continent. We discuss definitions and classification systems used in pediatric AKI literature. At present, despite some shortcomings, traditional Pediatric Risk Injury Failure Loss and End Stage Kidney Disease (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) systems are the most clinically useful. Alternative definitions, such as monitoring serum cystatin or novel urinary biomarkers, including cell cycle inhibitors, require more long-term studies in heterogenous pediatric AKI populations before they can be recommended in routine clinical practice...
June 15, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Gabriela Cobo, Manfred Hecking, Friedrich K Port, Isabella Exner, Bengt Lindholm, Peter Stenvinkel, Juan Jesús Carrero
Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care...
July 1, 2016: Clinical Science (1979-)
Chung-Liang Shih, Tuan-Hsun Chang, Dana A Jensen, Chiung-Hsuan Chiu
BACKGROUND: Dialysis has long been a critical issue in the field of nephrology, though the burden this lifesaving technology places on society can be immense. Effectively increasing the health literacy of hemodialysis patients can be beneficial for their health outcomes and self-care abilities. Thus, the aims of this study are to: (1) develop a health literacy assessment tool in Chinese for patients receiving hemodialysis treatment; (2) assess the health literacy level of the Taiwanese hemodialysis population using the tool developed...
2016: BMC Nephrology
David Collister, Randall Russell, Josee Verdon, Monica Beaulieu, Adeera Levin
PURPOSE OF REVIEW: To summarize a jointly held symposium by the Canadian Society of Nephrology (CSN), the Canadian Association of Nephrology Administrators (CANA), and the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) entitled "Perspectives on Optimizing Care of Patients in Multidisciplinary Chronic Kidney Disease (CKD) Clinics" that was held on April 24, 2015, in Montreal, Quebec. SOURCES OF INFORMATION: The panel consisted of a variety of members from across Canada including a multidisciplinary CKD clinic patient (Randall Russell), nephrology fellow (Dr...
2016: Canadian Journal of Kidney Health and Disease
Giovanni Montini, Alberto Edefonti, Yajaira Silva Galán, Mabel Sandoval Díaz, Marta Medina Manzanarez, Giuseppina Marra, Fabio Robusto, Gianni Tognoni, Fabio Sereni
BACKGROUND: The widely recognized clinical and epidemiological relevance of the socioeconomic determinants of health-disease conditions is expected to be specifically critical in terms of chronic diseases in fragile populations in low-income countries. However, in the literature, there is a substantial gap between the attention directed towards the medical components of these problems and the actual adoption of strategies aimed at providing solutions for the associated socioeconomic determinants, especially in pediatric populations...
2016: PloS One
Niraj Desai, Mahboob Rahman
End-stage renal disease (ESRD) is associated with high rates of morbidity and mortality, and increased health care use. Optimal management of patients with ESRD requires close collaboration among primary care physicians, nephrology subspecialists, and other subspecialists. Critical issues for the family physician include helping patients transition from chronic kidney disease to ESRD, recognizing and managing common issues in patients receiving dialysis or after kidney transplantation, and understanding palliative care for patients with ESRD...
May 2016: FP Essentials
Sharmeela Saha, Mahboob Rahman
Chronic kidney disease (CKD) affects more than 1 in 10 individuals in the United States. The care of these patients must be managed by family physicians and nephrology subspecialists. The kidneys often are affected by systemic processes such as diabetes and hypertension, and optimal management of these conditions is critical to slow decline in renal function in CKD patients. These patients are at high risk of cardiovascular disease, and statin therapy is recommended for adults with CKD who are at least age 50 years and not receiving dialysis...
May 2016: FP Essentials
Kathleen D Liu
No abstract text is available yet for this article.
May 2016: Advances in Chronic Kidney Disease
Ron Wald, Sean M Bagshaw
The optimal time to start renal replacement therapy (RRT) in the setting of acute kidney injury (AKI) is one of the most controversial questions in the field of critical care nephrology. An earlier or pre-emptive approach, whereby RRT is initiated in the absence of a life-threatening complication of AKI, may have a variety of plausible benefits. On the other hand, the widespread adoption of such an approach would consume more resources and would have to be justified by evidence of superior patient outcomes...
January 2016: Seminars in Nephrology
Amir Kazory
Heart failure remains a major public health concern because of its high prevalence, morbidity, mortality, and financial burden. The poor clinical outcomes associated with acute decompensated heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of extracorporeal isolated ultrafiltration in this setting. In this article, selected mechanistic aspects of ultrafiltration therapy are briefly reviewed followed by a critical overview of the largest trials in this field...
August 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Molly A Feely, Keith M Swetz, Kathryn Zavaleta, Björg Thorsteinsdottir, Robert C Albright, Amy W Williams
BACKGROUND: End-stage renal disease is a life-limiting illness associated with significant morbidity. Half of all individuals with end-stage renal disease are unable to participate in decision making at the end of life, which makes advance care planning critical in this population. OBJECTIVE: We sought to determine the feasibility of embedding palliative medicine consultations in the hemodialysis unit during treatment runs and the impact of this intervention on advance care planning and symptom management...
June 2016: Journal of Palliative Medicine
Sophia Lazenby, Adrian Edwards, Raymond Samuriwo, Stephen Riley, Mary Ann Murray, Andrew Carson-Stevens
BACKGROUND: Haemodialysis patients receive very little involvement in their end-of-life care decisions. Issues relating to death and dying are commonly avoided until late in their illness. This study aimed to explore the experiences and perceptions of doctors and nurses in nephrology for involving haemodialysis patients in end-of-life care decisions. METHODS: A semi-structured qualitative interview study with 15 doctors and five nurses and thematic analysis of their accounts was conducted...
March 10, 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Tokiko Miyaoka, Mitsuyo Itabashi, Saeko Kumon, Kenichi Akiyama, Yuko Iwabuchi, Hiroshi Kataoka, Takahito Moriyama, Takashi Takei, Kosaku Nitta
We report a patient treated with rituximab for interstitial pneumonia (IP) associated with microscopic polyangiitis (MPA) and who was undergoing hemodialysis. A 59-year-old woman who had been treated with tacrolimus for 1 year for rheumatic arthritis was referred to the Department of Nephrology for fatigue, fever, weight loss, and rapidly developing renal dysfunction. On the first admission, severe renal dysfunction, proteinuria, hematuria, and an elevated titer of MPO-ANCA were observed, and the woman was diagnosed with rapidly progressive glomerulonephritis because of MPA...
2016: Nihon Jinzo Gakkai Shi
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
Magdalena Bartmańska, Andrzej Więcek
Along with instant aging of the world population the prevalence of chronic kidney disease is constantly growing. Over the past decade, the largest increase in the incidence of end-stage CKD was observed especially among subjects aged 80 and over. Realizing that renal replacement therapy is a heavy burden on health care it is critical to prevent end-stage kidney disease. To do so the risk and predisposing factors leading to development of renal failure have to be recognized. Among them are comorbidities such as diabetes, hypertension significantly associated with elderly, but also numerous of socioeconomics aspects...
February 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Chih-Yuan Huang, Chia-Wen Hsu, Chi-Rou Chuang, Ching-Chih Lee
BACKGROUND AND OBJECTIVES: Pre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis. DESIGN, SETTING PARTICIPANTS, & MEASUREMENTS: The study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008...
2016: PloS One
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