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ICU nephrology

D J Askenazi, Michael Heung, Michael J Connor, Rajit K Basu, Jorge Cerdá, Kent Doi, Jay L Koyner, Azra Bihorac, Ladan Golestaneh, Anitha Vijayan, Mark D Okusa, Sarah Faubel
As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU...
December 3, 2016: Blood Purification
Lilia Rizo-Topete, Claudio Ronco
Acute kidney injury (AKI) is a serious medical condition affecting millions of people. Patients in intensive care unit (ICU) who develop AKI have increased morbidity and mortality, prolonged length of stay in ICU and hospital and increased costs, especially when they require renal replacement therapy. In the latter case, morbidity and mortality increase further. In order to meet the needs of the critically ill patients, a multidisciplinary care team is required, combining the efforts of physicians and nurses from different disciplines as well as nephrologists and intensivists...
December 3, 2016: Blood Purification
Giuseppe Quintaliani, Marina Di Luca, Anteo Di Napoli, Giusto Viglino, Maurizio Postorino, Alessandro Amore, Simeone Andrulli, Antonio Bellasi, Giuliano Brunori, Erasmo Buongiorno, Santina Castellino, Alessandro D'Amelio, Luca De Nicola, Loreto Gesualdo, Domenico Di Landro, Sandro Feriozzi, Giovanni Strippoli, Ugo Teatini, Antonio Santoro
BACKGROUND: Given the public health challenge and burden of chronic kidney disease, the Italian Society of Nephrology (SIN) promoted acensusof the renal and dialysis units to analyse structural and human resources, organizational aspects, activities and workload referring to theyear 2014. METHODS: An online questionnaire, including 64 items exploring structural and human resources, organization aspects, activities and epidemiological data referred to 2014, was sent to chiefs of any renal or dialysis unit...
September 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Hannelore Sprenger-Mähr, Emanuel Zitt, Karl Lhotta
INTRODUCTION: The number of patients suffering from acute kidney injury requiring dialysis (AKI-D) is increasing. Whereas causes and outcome of AKI-D in the intensive care unit (ICU) are described extensively, few data exist about AKI-D patients treated outside the ICU. Aim of this study was to identify the causes of AKI-D, determine in-depth the comorbid conditions and outcome of this particular patient group and identify possibilities for its prevention. METHODS: We retrospectively studied all AKI-D patients treated outside the ICU in a single nephrology referral center between January 2010 and June 2015...
2016: PloS One
Wouter De Corte, Annemieke Dhondt, Raymond Vanholder, Jan De Waele, Johan Decruyenaere, Veerle Sergoyne, Joke Vanhalst, Stefaan Claus, Eric A J Hoste
BACKGROUND: In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT. METHODS: We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital...
August 12, 2016: Critical Care: the Official Journal of the Critical Care Forum
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
Mark D Cipolle, Bailey C Ingraham Lopresto, Joan M Pirrung, Erin M Meyer, Christine Manta, Alexandra S Nightingale, Edmondo J Robinson, Glen H Tinkoff
BACKGROUND: Recognizing the increasing age and comorbid conditions of patients admitted to our trauma service, we embedded a hospitalist on the trauma service at our Level I trauma center.This program was initiated in January 2013. This study was designed to investigate differences in outcomes between trauma patients who received care from the trauma hospitalist (THOSP) program and similarly medically complex trauma patients who did not receive THOSP care. METHODS: There were 566 patients comanaged with THOSP between December 2013 and November 2014...
July 2016: Journal of Trauma and Acute Care Surgery
Claire Rimes-Stigare, Paolo Frumento, Matteo Bottai, Johan Mårtensson, Claes-Roland Martling, Max Bell
INTRODUCTION: Prevalence of chronic kidney disease (CKD) amongst intensive care unit (ICU) admissions is rising. How mortality and risk of end-stage renal disease (ESRD) differs between those with and without CKD and with acute kidney injury (AKI) is unclear. Determining factors that increase the risk of ESRD is essential to optimise treatment, identify patients requiring nephrological surveillance and for quantification of dialysis provision. METHOD: This cohort study used the Swedish intensive care register 2005-2011 consisting of 130,134 adult patients...
November 3, 2015: Critical Care: the Official Journal of the Critical Care Forum
Jorge Ruiz-Criado, Maria-Angeles Ramos-Barron, Gema Fernandez-Fresnedo, Emilio Rodrigo, Angel-Luis Martin De Francisco, Manuel Arias, Carlos Gomez-Alamillo
BACKGROUND: Epidemiological studies of acute kidney injury (AKI) have focused on patients admitted to intensive care units (ICUs), and several have studied hospitalized non-ICU patients, but analysis of patients referred to Nephrology is sparse. We analyzed factors associated with short- and long-term morbimortality among hospitalized non-ICU patients with AKI who were referred to Nephrology. METHODS: A retrospective study with data prospectively collected from 170 non-ICU patients, with referral to the Nephrology Unit, recruited over a 4-year period, was performed...
2015: Nephron
Christopher J Kirwan, Mark J Blunden, Hamish Dobbie, Ajith James, Ambika Nedungadi, John R Prowle
BACKGROUND: Episodes of acute kidney injury (AKI) have been associated with the development of chronic kidney disease (CKD). However, follow-up pathways for patients who have survived AKI complicating critical illness are not well established. We hypothesised that patients who had AKI requiring renal replacement therapy (RRT) in intensive care are at risk of CKD, but are rarely referred for nephrology follow-up at hospital discharge. METHODS: We performed a retrospective analysis of all patients who survived AKI requiring renal replacement therapy in intensive care units (ICUs) in the East London region, examining renal function at baseline, hospital discharge and 3-6 months follow-up...
2015: Nephron
Sergio Pinto de Souza, Rodrigo Santos Matos, Luisa Leite Barros, Paulo Novis Rocha
INTRODUCTION: Sepsis is a leading precipitant of Acute Kidney Injury (AKI) in intensive care unit (ICU) patients, and is associated with a high mortality rate. OBJECTIVE: We aimed to evaluate the risk factors for dialysis and mortality in a cohort of AKI patients of predominantly septic etiology. METHODS: Adult patients from an ICU for whom nephrology consultation was requested were included. End-stage chronic renal failure and kidney transplant patients were excluded...
October 2014: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Patrick M Honoré, Rita Jacobs, Olivier Joannes-Boyau, Elisabeth De Waele, Jouke De Regt, Viola Van Gorp, Herbert D Spapen
Emergency and critical care medicine have grown into robust self-supporting disciplines with an increasing demand for dedicated highly-skilled physicians. In the past, "core" specialists were asked to offer bedside advice in acute care wards. In the same regard, critical care medicine and nephrology have been fighting but finally emerged altogether with the concept of critical care nephrology almost 20 years ago. Indeed, polyvalence is no longer a valid option in modern critical care. Uniting forces between disciplines represents the only way to cope with the increasing complexity and cumulating knowledge in the critical care setting...
2014: International Journal of Nephrology and Renovascular Disease
Rémi Bruyère, Agnès Soudry-Faure, Gilles Capellier, Christine Binquet, Abdelouaid Nadji, Stephane Torner, Gilles Blasco, Maria Yannaraki, Saber Davide Barbar, Jean-Pierre Quenot
BACKGROUND: The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters...
November 19, 2014: Trials
Marcelle Aquino Rabelo, Armando Monteiro Bezerra Neto, Stéfany Ojaimi Loibman, Jailton Lobo da Costa Lima, Ewerton Lucena Ferreira, Nilma Cintra Leal, Maria Amélia Vieira Maciel
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) strains have been responsible for many nosocomial outbreaks. Within hospitals, colonized employees often act as reservoirs for the spread of this organism. This study collected clinical samples of 91 patients admitted to the intensive care unit (ICU), hemodialysis/nephrology service and surgical clinic, and biological samples from the nasal cavities of 120 professionals working in those environments, of a University Hospital in Recife, in the State of Pernambuco, Brazil...
July 2014: Revista da Sociedade Brasileira de Medicina Tropical
Riccardo Maria Fagugli, Francesco Patera, Sara Battistoni, Francesca Mattozzi, Giovanni Tripepi
Evidence regarding hospital-based acute kidney injury (AKI) reveals a continuous increase in incidence over the years, at least in intensive care units (ICU). Fewer reports are available for non critically-ill patients admitted to general or specialist wards other than ICU (non-ICU). The consequence of greater incidence is an increase in therapies such as dialysis; but how the health care organization deals with this problem is not clearly known. Here we quantified the incidence of dialysis-requiring AKI (AKI-D) among patients admitted to a University Hospital which serves a population of 354,000 inhabitants...
June 2015: Journal of Nephrology
Muhammad R Toor, Anjali Singla, Maria V DeVita, Jordan L Rosenstock, Michael F Michelis
PURPOSE: Hypernatremia is a common electrolyte disorder associated with adverse outcomes such as increased length of stay and mortality due to a variety of factors. Our aim was to investigate known factors as well as other variables which we had identified in hospitalized hypernatremic geriatric patients and their relationship to patient outcomes. METHODS: A retrospective chart review of all adult hospitalized patients in a 4-month period with a serum sodium level >150 mmol/L was performed...
August 2014: International Urology and Nephrology
Aaron Wightman, Emily Largent, Mark Del Beccaro, John D Lantos
Administrators sometimes face ethical dilemmas about the allocation of institutional resources. One such situation is when elective surgery cases require reserved ICU beds and the ICU is full. Such situations arise frequently in children's hospitals today. They are sometimes complicated by questions about whether every patient in the ICU belongs there. We present such a situation and responses from Mark Del Becarro, Vice President for Medical Affairs at Seattle Children's Hospital; Aaron Wightman, a nephrology fellow and bioethicist at Seattle Children's Hospital; and Emily Largent, a doctoral student in the joint JD/PhD Program in Health Policy at Harvard University...
May 2014: Pediatrics
Gholamreza Khademi, Masoumeh Roudi, Ahmad Shah Farhat, Masoud Shahabian
INTRODUCTION: The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB). Higher noise levels than the maximum level result in patient's instability and dissatisfaction. Moreover, it will have serious negative effects on the staff's health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad...
2011: Iranian Journal of Otorhinolaryngology
Eric A J Hoste, Wouter De Corte
PURPOSE OF REVIEW: Acute kidney injury (AKI) is a frequent finding in critically ill patients and is associated with adverse outcomes. With the purpose of improving outcome of AKI, the Kidney Disease: Improving Global Outcomes (KDIGO) group, a group of experts in critical care nephrology, has presented a set of guidelines in 2012, based on the evidence gathered until mid 2011. This review will update these guidelines with recent evidence. RECENT FINDINGS: Early application of a set of therapeutic measures - a bundle - is advised for the prevention and therapy of AKI...
December 2013: Current Opinion in Critical Care
Malte Heeg, Alexander Mertens, David Ellenberger, Gerhard A Müller, Daniel Patschan
BACKGROUND: AKI significantly worsens prognosis of hospitalized patients. This is particularly the case in patients with sepsis. The risk for aquiring sepsis is significantly increased in malignant diseases. Aim of the present retrospective study was to analyze outcomes of tumor patients with sepsis and AKI. METHODS: One-thousand and seventeen patients, treated at the ICU of the Department of Nephrology and Rheumatology of the University Hospital Göttingen from 2009 to 2011 were retrospectively analyzed for mortality, sepsis, AKI, need for renal replacement therapy (dialysis) and malignancies...
2013: BMC Anesthesiology
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