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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
D R McIlroy, R Bellomo, F T Billings, K Karkouti, J R Prowle, A D Shaw, P S Myles
BACKGROUND: Renal injury is a common perioperative complication. The adoption of renal endpoints, standardised and valid for use in perioperative clinical trials, would enhance the quality of perioperative clinical research. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive standardised endpoints for use in perioperative clinical trials. METHODS: A systematic review was conducted to identify renal endpoints currently reported in perioperative clinical trials...
November 2018: British Journal of Anaesthesia
Pavan K Bhatraju, Leila R Zelnick, Jerald Herting, Ronit Katz, Carmen Mikacenic, Susanna Kosamo, Eric D Morrell, Cassianne Robinson-Cohen, Carolyn S Calfee, Jason D Christie, Kathleen D Liu, Michael A Matthay, William O Hahn, Victoria Dmyterko, Natalie S J Slivinski, Jim A Russell, Keith R Walley, David C Christiani, W Conrad Liles, Jonathan Himmelfarb, Mark M Wurfel
OBJECTIVE: The aim of this study was to identify and test whether AKI sub-phenotypes have prognostic and therapeutic implications. METHODS: First, latent class analysis methodology was applied independently in two critically ill populations (Discovery: n=794 and Replication: n=425) with AKI. Second, a parsimonious classification model was developed to identify AKI sub-phenotypes. Third, the classification model was applied to patients with AKI in the Vasopressin in Septic Shock (VASST: n=271) clinical trial and differences in treatment response were determined...
October 18, 2018: American Journal of Respiratory and Critical Care Medicine
Simon Sawhney, Monica Beaulieu, Corri Black, Ognjenka Djurdjev, Gabriela Espino-Hernandez, Angharad Marks, David J McLernon, Zainab Sheriff, Adeera Levin
Background: Outcomes after acute kidney injury (AKI) are well described, but not for those already under nephrology clinic care. This is where discussions about kidney failure risk are commonplace. We evaluated whether the established kidney failure risk equation (KFRE) should account for previous AKI episodes when used in this setting. Methods: This observational cohort study included 7491 people referred for nephrology clinic care in British Columbia in 2003-09 followed to 2016...
October 15, 2018: Nephrology, Dialysis, Transplantation
John A Kellum, Norbert Lameire
No abstract text is available yet for this article.
January 20, 2018: Lancet
Paul M Palevsky
BACKGROUND: The selection of appropriate endpoints is critical to the success of any clinical trial. Endpoints need to be precisely defined and need to provide an appropriate balance between sensitivity for detection of the effects of the intervention of interest and specificity for the outcome of interest. SUMMARY: In acute kidney injury (AKI), the 2 most common endpoints utilized either rely on small, short-term changes in serum creatinine or are a composite of longer term major adverse kidney events, including death, need for dialysis, and a persistent decline in kidney function...
2018: Nephron
Ian J Stewart, Jonathan A Bolanos, Dustin J Little, Kevin K Chung, Jonathan A Sosnov, Nancy Miller, Mark D Poirier, Kristin K Saenz, Vivian C McAlister, Soraya Moghadam, Ray Kao, Zsolt T Stockinger
Acute kidney injury is a recognized complication of combat trauma. The complications associated with acute kidney injury, such as life-threatening hyperkalemia, are usually delayed in onset. In the recent conflicts, rapid evacuation of U.S. and coalition personnel generally resulted in these complications occurring at higher echelons of care where renal replacement therapies were available. In the future however, deployed providers may not have this luxury and should be prepared to temporize patients while they await transport...
September 1, 2018: Military Medicine
Tuvya Y van Dijk, Ruth Rahamimov, Avry Chagnac, David J van Dijk, Eytan Mor, Amir Shlomai, Benaya Rozen-Zvi
AIM: To assess the incidence of acute kidney injury (AKI) and its common etiologies in kidney transplant recipients and the effect of AKI's characteristics on graft survival. METHODS: In a retrospective longitudinal cohort study, all serum creatinine (SCr) values of patients that had kidney transplantation between 01/2002-12/2010 were retrieved. AKI was defined as a 50% increase in SCr. Etiologies, recurrence, timing, and kidney function dynamics during the event were evaluated...
October 2018: Clinical Transplantation
Kent Doi, Osamu Nishida, Takashi Shigematsu, Tomohito Sadahiro, Noritomo Itami, Kunitoshi Iseki, Yukio Yuzawa, Hirokazu Okada, Daisuke Koya, Hideyasu Kiyomoto, Yugo Shibagaki, Kenichi Matsuda, Akihiko Kato, Terumasa Hayashi, Tomonari Ogawa, Tatsuo Tsukamoto, Eisei Noiri, Shigeo Negi, Koichi Kamei, Hirotsugu Kitayama, Naoki Kashihara, Toshiki Moriyama, Yoshio Terada
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search...
2018: Journal of Intensive Care
Jennifer S McDonald, Erik M Steckler, Robert J McDonald, Richard W Katzberg, Eric E Williamson, Joseph G Cernigliaro, Abdurrahman M Hamadah, Kamel Gharaibeh, David F Kallmes, Nelson Leung
OBJECTIVE: To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality. PATIENTS AND METHODS: All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded...
July 2018: Mayo Clinic Proceedings
John A Kellum, Rinaldo Bellomo, Claudio Ronco
No abstract text is available yet for this article.
August 7, 2018: JAMA: the Journal of the American Medical Association
Sul A Lee, Martina Cozzi, Errol L Bush, Hamid Rabb
Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Dysfunction of other organs is an important cause of poor outcomes from AKI. Ample clinical and epidemiologic data show that AKI is associated with distant organ dysfunction in lung, heart, brain, and liver. Recent advancements in basic and clinical research have demonstrated physiologic and molecular mechanisms of distant organ interactions in AKI, including leukocyte activation and infiltration, generation of soluble factors such as inflammatory cytokines/chemokines, and endothelial injury...
June 1, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Shigeo Negi, Daisuke Koreeda, Sou Kobayashi, Takuro Yano, Koichi Tatsuta, Toru Mima, Takashi Shigematsu, Masaki Ohya
Acute kidney injury (AKI) is one of the most common serious complications for all hospital admissions, with its incidence increasing among hospitalized patients, particularly those in the intensive care unit. Despite significant improvements in critical care and dialysis technology, AKI is associated with an increased risk of short- and long-term mortality, prolonged hospital stays, and dialysis dependence. These risks are particularly relevant for critically ill patients with AKI severe enough to require renal replacement therapy (RRT)...
September 2018: Seminars in Dialysis
Swati Mehta, Kinsuk Chauhan, Achint Patel, Shanti Patel, Rachel Pinotti, Girish N Nadkarni, Chirag R Parikh, Steven G Coca
BACKGROUND: Acute kidney injury (AKI), as defined by peak increase in serum creatinine, is independently associated with increased risk of mortality and length of stay. Studies have suggested that the duration of AKI may be an important additional or independent prognostic marker of increased mortality in patients with AKI across clinical settings. We performed a systematic review and meta-analysis of published studies to assess the impact of duration of AKI on outcomes. METHODS: Various bibliographic databases (MEDLINE, Embase, Cochrane Library, CINAHL and Web of Science) were searched through database inception to December 2015...
April 19, 2018: BMC Nephrology
Mayra Gonçalves Menegueti, Natália Cristina Betoni, Fernando Bellissimo-Rodrigues, Elen Almeida Romão
INTRODUCTION: Bloodstream infections are the second most common cause of death among patients on hemodialysis. This study aimed to evaluate the incidence of and risk factors associated with central venous catheter-related infections in patients undergoing hemodialysis, and to identify and characterize the type and antimicrobial susceptibility profiles of the primary microorganisms isolated during one year of follow-up. METHODS: A prospective cohort study was conducted in 2014 in a hemodialysis referral center...
November 2017: Revista da Sociedade Brasileira de Medicina Tropical
Anna Zuk, Paul M Palevsky, Linda Fried, Frank E Harrell, Samina Khan, Dianne B McKay, Luke Devey, Lakhmir Chawla, Mark de Caestecker, James S Kaufman, B Taylor Thompson, Anupam Agarwal, Tom Greene, Mark Douglas Okusa, Joseph V Bonventre, Laura M Dember, Kathleen D Liu, Benjamin D Humphreys, Daniel Gossett, Yining Xie, Jenna M Norton, Paul L Kimmel, Robert A Star
AKI is a complex clinical condition associated with high mortality, morbidity, and health care costs. Despite improvements in methodology and design of clinical trials, and advances in understanding the underlying pathophysiology of rodent AKI, no pharmacologic agent exists for the prevention or treatment of AKI in humans. To address the barriers that affect successful clinical translation of drug targets identified and validated in preclinical animal models of AKI in this patient population, the National Institute of Diabetes and Digestive and Kidney Diseases convened the "AKI Outcomes: Overcoming Barriers in AKI" workshop on February 10-12, 2015...
July 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Pierpaolo Di Nicolò
Renal involvement in some forms of acute or chronic diseases, such as heart failure or sepsis, presents with a complex pathophysiological basis that is not always clearly distinguishable. In these clinical settings, kidney failure is traditionally and almost exclusively attributed to renal hypoperfusion and it is commonly accepted that causal elements are pre-renal, such as a reduction in the ejection fraction or absolute or relative hypovolemia acting directly on oxygen transport mechanisms and renal autoregulation systems, causing a reduction of glomerular filtration rate...
March 2018: Heart Failure Reviews
M Piraprez, K Quinonez, M Sempels, D Waltrégny, J-M Krzesinski, F Jouret
The syndrome of "post-obstructive diuresis" corresponds to a massive polyuria and natriuresis occurring after the drainage of an obstructive acute kidney injury. Such a complication needs to be readily detected and managed because of the significant risk for haemodynamic disorders. On the basis of a clinical observation, we describe the pathophysiology of post-obstructive diuresis, as well as its diagnostic and therapeutic management.
December 2017: Revue Médicale de Liège
Zhiyong Peng, Kaijiang Yu, Marlies Ostermann, XiuMing Xi, Raymond Hsu, Jean-Louis Vincent, John R Prowle, Bin Du, Martin Gallagher, Changsong Wang, Raghavan Murugan, Haibo Qiu, Thomas Rimmelé, Jianguo Li, Lui G Forni, Kianoush Kashani, Claudio Ronco, John A Kellum
PURPOSE: Acute kidney injury (AKI) has become a major medical and financial burden in China along with the rest of the world. There have been considerable advances in the understanding of the epidemiology and pathogenesis of AKI. However, there is no consensus regarding the optimal care for patients. The Acute Disease Quality Initiative (ADQI) 19 meeting focused on identifying and designing relevant and achievable AKI-related studies in China. MATERIALS & METHODS: The working group developed a list of preliminary questions and objectives and performed analysis of the existing literature...
April 2018: Journal of Critical Care
Tim Mitchell, Elisabeth Feher, Gillian Mitchell, Aron Chakera
Acute kidney injury (AKI) in hospitalised patients is associated with adverse outcomes; however, it remains unrecognised and under-reported. A total of 48 045 serum creatinine results from 8129 tertiary hospital inpatients were reviewed. The prevalence of AKI was 4.33%. Mortality was significantly higher in patients with AKI (16.76%) compared to those without AKI (1.88%, P < 0.001). Documentation of AKI in discharge summaries was poor.
December 2017: Internal Medicine Journal
Lynne Sykes, Rob Nipah, Philip Kalra, Darren Green
Acute kidney injury (AKI) is independently associated with significant morbidity and mortality, and is thus an important challenge facing physicians in modern healthcare. This narrative review assesses the impact of strategies employed to tackle AKI following the 2009 NCEPOD report on acute kidney injury (Sterwart et al. Acute kidney injury: adding insult to injury, pp 1-22, 2009). There is scarce and heterogeneous research into hard end points such as mortality and AKI progression for AKI interventions. This review found that e-alerts have varying effects on mortality and AKI progression, but decrease the incidence of contrast-induced AKI...
August 2018: Journal of Nephrology
2017-12-03 07:05:20
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