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Sustained low-efficiency dialysis

Giuseppe Regolisti, Riccardo Antoniotti, Filippo Fani, Paolo Greco, Enrico Fiaccadori
Metformin intoxication with lactic acidosis, a potentially lethal condition, may develop in diabetic patients when the drug dose is inappropriate and/or its clearance is reduced. Diagnosis and therapy may be delayed due to nonspecific symptoms at presentation, with severe anion gap metabolic acidosis and elevated serum creatinine values being the most prominent laboratory findings. Confirmation requires measurement of serum metformin by high-performance liquid chromatography-tandem mass spectrometry, but this technique is available only at specialized institutions and cannot be relied on as a guide to immediate treatment...
February 17, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Christina König, Stephan Braune, Jason A Roberts, Axel Nierhaus, Oliver M Steinmetz, Michael Baehr, Otto R Frey, Claudia Langebrake, Stefan Kluge
No abstract text is available yet for this article.
February 8, 2017: Journal of Antimicrobial Chemotherapy
Shakti Bedanta Mishra, Ratender Kumar Singh, Arvind Kumar Baronia, Banani Poddar, Afzal Azim, Mohan Gurjar
AIM OF THE STUDY: Acute kidney injury (AKI) in septic shock has poor outcomes. Sustained low-efficiency dialysis (SLED) is increasingly replacing continuous renal replacement therapy as the preferred modality in Intensive Care Units (ICUs). However, the essential aspects of hemodynamic tolerability and efficacy of SLED in septic shock AKI has been minimally studied. PATIENTS AND METHODS: We describe hemodynamic tolerability using modified vasopressor index (VI) and vasopressor dependency (VD) and efficacy using a combination of Kt/v, correction of acidosis, electrolyte, and fluid overload...
December 2016: Indian Journal of Critical Care Medicine
Paolo Greco, Giuseppe Regolisti, Riccardo Antoniotti, Caterina Maccari, Elisabetta Parenti, Silvia Corrado, Enrico Fiaccadori
Metformin is recommended as the treatment of choice in patients with type 2 diabetes mellitus because of its efficacy, general tolerability and low cost. Recent guidelines have extended the use of metformin to patients with Chronic Kidney Disease (CKD) up to stage III. However, in the recent literature, cases of MALA (metformin-associated lactic acidosis) are increasingly reported. MALA is the most dangerous side effect of the drug, with an incidence rate of 2-9 cases per 100000 person-years of exposure. We report on two patients with accidental metformin overdose, severe lactic acidosis and acute kidney injury...
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Bernadett Kovacs, Katrina J Sullivan, Swapnil Hiremath, Rakesh V Patel
Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. Controversy remains regarding the optimal renal replacement intervention for these patients. Our systematic review aimed to determine the effect(s) of sustained low-efficiency dialysis (SLED) compared with continuous renal replacement (CRRT) therapy on relevant patient outcomes. A systematic search of Medline, Embase, CINAHL and the Cochrane Library was conducted. Identified citations were screened independently in duplicate for relevance, and the methodological quality of included studies was evaluated...
May 2017: Nephrology
Daniel Fb Wright, Matthew P Doogue, Murray L Barclay, Peter T Chapman, Nicholas B Cross, John H Irvine, Lisa K Stamp
PURPOSE: The aims of this study were to characterise the population pharmacokinetics of oxypurinol in patients receiving haemodialysis and to compare oxypurinol exposure in dialysis and non-dialysis patients. METHODS: Oxypurinol plasma concentrations from 6 gout people receiving haemodialysis and 19 people with gout not receiving dialysis were used to develop a population pharmacokinetic model in NONMEM. Deterministic simulations were used to predict the steady-state area under the oxypurinol plasma concentration time curve over 1 week (AUC7days)...
January 2017: European Journal of Clinical Pharmacology
Sérgio Aparecido Cleto, Camila Eleutério Rodrigues, Ceila Maria Malaque, Jaques Sztajnbok, Antônio Carlos Seguro, Lúcia Andrade
BACKGROUND: Leptospirosis is a health problem worldwide. Its most severe form is a classic model of sepsis, provoking acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), with associated mortality that remains unacceptably high. We previously demonstrated that early initiation of sustained low-efficiency dialysis (SLED) followed by daily SLED significantly decreases mortality. However, the mode of clearance can also affect dialysis patient outcomes. Therefore, the objective of this study was to compare the effects of SLED with traditional (diffusive) clearance, via hemodialysis, and SLED with convective clearance, via hemodiafiltration (SLEDf), in patients with severe leptospirosis...
2016: PloS One
Finnian R Mc Causland, Josephine Asafu-Adjei, Rebecca A Betensky, Paul M Palevsky, Sushrut S Waikar
BACKGROUND AND OBJECTIVES: Intensive RRT may have adverse effects that account for the absence of benefit observed in randomized trials of more intensive versus less intensive RRT. We wished to determine the association of more intensive RRT with changes in urine output as a marker of worsening residual renal function in critically ill patients with severe AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Acute Renal Failure Trial Network Study (n=1124) was a multicenter trial that randomized critically ill patients requiring initiation of RRT to more intensive (hemodialysis or sustained low-efficiency dialysis six times per week or continuous venovenous hemodiafiltration at 35 ml/kg per hour) versus less intensive (hemodialysis or sustained low-efficiency dialysis three times per week or continuous venovenous hemodiafiltration at 20 ml/kg per hour) RRT...
August 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Wolfgang Huber, Stephan Fuchs, Andreas Minning, Claudius Küchle, Marlena Braun, Analena Beitz, Caroline Schultheiss, Sebastian Mair, Veit Phillip, Sebastian Schmid, Roland M Schmid, Tobias Lahmer
BACKGROUND: Acute kidney injury (AKI) is common in critically ill patients. AKI requires renal replacement therapy (RRT) in up to 10% of patients. Particularly during connection and fluid removal, RRT frequently impairs haemodyamics which impedes recovery from AKI. Therefore, "acute" connection with prefilled tubing and prolonged periods of RRT including sustained low efficiency dialysis (SLED) has been suggested. Furthermore, advanced haemodynamic monitoring using trans-pulmonary thermodilution (TPTD) and pulse contour analysis (PCA) might help to define appropriate fluid removal goals...
2016: PloS One
Frances Fothergill Bourbonnais, Sharon Slivar, Sue Malone Tucker
BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices...
2016: Canadian Journal of Critical Care Nursing
Peng Ji, Tong Yu, Ying Liu, Jie Jiang, Jie Xu, Ying Zhao, Yanna Hao, Yang Qiu, Wenming Zhao, Chao Wu
Naringenin (NRG), a flavonoid compound, had been reported to exhibit extensive pharmacological effects, but its water solubility and oral bioavailability are only~46±6 µg/mL and 5.8%, respectively. The purpose of this study is to design and develop NRG-loaded solid lipid nanoparticles (NRG-SLNs) to provide prolonged and sustained drug release, with improved stability, involving nontoxic nanocarriers, and increase the bioavailability by means of pulmonary administration. Initially, a group contribution method was used to screen the best solid lipid matrix for the preparation of SLNs...
2016: Drug Design, Development and Therapy
Pei Zhang, Huiyuan Zhang, Wenxiu He, Dujuan Zhao, Aixin Song, Yuxia Luan
Here, we prepared novel redox-sensitive drug delivery system based on copolymer-drug conjugates methoxy poly(ethylene glycol)-poly(γ-benzyl l-glutamate)-disulfide-docetaxel (mPEG-PBLG-SS-DTX) to realize the desirable cancer therapy. First, copolymers of methoxy poly(ethylene glycol)-poly(γ-benzyl l-glutamate) (mPEG-PBLGs) with different molecular weight (mPEG2000-PBLG1750 and mPEG5000-PBLG1750) were synthesized via the ring open polymerization (ROP) of 5-benzyl-l-glutamate-N-carboxyanhydride (γ-Bzl-l-Glu-NCA) initiated by monoamino-terminated mPEG (mPEG-NH2)...
May 9, 2016: Biomacromolecules
Jian P Mei, Azadeh Ali-Moghaddam, Bruce A Mueller
BACKGROUND: The use of hybrid renal replacement therapies like sustained low efficiency dialysis (SLED) is increasing in ICUs worldwide. However, pharmacokinetic studies designed to inform therapeutic antibiotic dosing in critically ill patients receiving SLED are limited. SLED operational characteristics vary across institutions. Pharmacists in institutions that utilize SLED are challenged to recommend therapeutic doses for antibiotics. OBJECTIVE: To characterize pharmacist-recommended antibiotic regimens for SLED...
February 2016: International Journal of Clinical Pharmacy
Tamar Phirtskhalaishvili, Florian Bayer, Stephane Edet, Isabelle Bongiovanni, Julien Hogan, Cécile Couchoud
UNLABELLED:BACKGROUND: Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities...
May 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Sonali, Poornima Agrawal, Rahul Pratap Singh, Chellappa V Rajesh, Sanjay Singh, Mahalingam R Vijayakumar, Bajrangprasad L Pandey, Madaswamy Sona Muthu
The effective treatment of brain cancer is hindered by the poor transport across the blood-brain barrier (BBB) and the low penetration across the blood-tumor barrier (BTB). The objective of this work was to formulate transferrin-conjugated docetaxel (DTX)-loaded d-alpha-tocopheryl polyethylene glycol 1000 succinate (vitamin E TPGS or TPGS) micelles for targeted brain cancer therapy. The micelles with and without transferrin conjugation were prepared by the solvent casting method and characterized for their particle size, polydispersity, drug encapsulation efficiency, drug loading, in vitro release study and brain distribution study...
June 2016: Drug Delivery
Weng C Oh, David S Gardner, Mark A J Devonald
PURPOSE OF REVIEW: A wide range of renal replacement therapies is now available to support patients with acute kidney injury. These treatments utilize diffusion, convection or a combination of these mechanisms to remove metabolic waste products from the bloodstream. It is inevitable that physiologically important substances including micronutrients will also be removed. Here we review current knowledge of the extent of micronutrient loss, how it varies between treatment modalities and its clinical significance...
November 2015: Current Opinion in Clinical Nutrition and Metabolic Care
Renato A Caires, Regina C R M Abdulkader, Verônica T Costa E Silva, Gillene S Ferreira, Emmanuel A Burdmann, Luis Yu, Etienne Macedo
BACKGROUND: Single-pass batch dialysis (SBD) is a well-established system for treatment of end-stage renal disease. However, little evidence is available on sustained low-efficiency extended dialysis (SLED) performed with SBD in patients with acute kidney injury (AKI) in the intensive care unit (ICU). METHODS: All SLED-SBD sessions conducted on AKI patients in nine ICUs between March and June 2010 were retrospectively analyzed regarding the achieved metabolic and fluid control...
June 2016: Journal of Nephrology
Tobias Lahmer, Marlena Messer, Sebastian Rasch, Analena Beitz, Christopher Schnappauf, Roland M Schmid, Wolfgang Huber
PURPOSE: Patients with liver failure requiring dialysis are at increased risk for citrate accumulation during sustained low-efficiency dialysis (SLED). The aim of this study was to evaluate the feasibilty of citrate SLED in critical ill patients with liver failure and investigate predictive parameters regarding citrate accumulation. MATERIALS AND METHODS: This is a prospective study in 24 medical intensive care unit patients with liver failure and a total of 43 SLED runs (maximum of 3 runs per patient) using citrate anticoagulation...
October 2015: Journal of Critical Care
Abhijat Kitchlu, Neill Adhikari, Karen E A Burns, Jan O Friedrich, Amit X Garg, David Klein, Robert M Richardson, Ron Wald
BACKGROUND: Sustained low efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. SLED may reduce the hemodynamic perturbations of intermittent hemodialysis, while obviating the resource demands of CRRT. Although SLED is being increasingly used, few studies have evaluated its impact on clinical outcomes. METHODS: We conducted a cohort study comparing SLED (target 8 h/session, blood flow 200 mL/min, predominantly without anticoagulation) to CRRT in four ICUs at an academic medical centre...
August 4, 2015: BMC Nephrology
Mourad M Alsabbagh, A Ahsan Ejaz, Daniel L Purich, Edward A Ross
BACKGROUND: Slow continuous ultrafiltration (SCUF) is a safe and efficient treatment for fluid overload in patients who are hemodynamically unstable, have low urine output, and are not in need of dialysis or hemofiltration for solute clearance. Sustained anticoagulation is required for these long treatments, thus posing clinically challenges for patients having contraindications to systemic anticoagulation with heparin. Regional citrate anticoagulation would be an alternative option; however, we believed that this would be problematic due to citrate kinetics that predicted the development of metabolic alkalosis...
June 2012: Clinical Kidney Journal
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