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Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA: the Journal of the American Medical Association
Pietro Ravani, Paul E Ronksley, Matthew T James, Giovanni F Strippoli
Systematic reviews are an ideal way of summarizing evidence from primary studies. While systematic reviews of randomized trials are broadly used to summarize benefits and harms of interventions, systematic reviews of observational studies are useful to summarize data on prevalence of risk factors in a population, distribution of outcomes or associations of different risk factors with outcomes. Also, systematic reviews can be useful to clarify potential reasons for conflicting data found in primary studies and explore sources of heterogeneity (variation in primary study data) to better understand epidemiological data and generate hypotheses for candidate interventions to improve outcomes...
October 2015: Nephrology, Dialysis, Transplantation
A Michael Lincoff
In managing acute coronary syndromes, physicians can draw on a large body of evidence from clinical trials. This article reviews clinical trials that inform current standards of practice regarding reperfusion, aggressive vs conservative initial approaches, and the appropriate use of aspirin, dual antiplatelet therapy, glycoprotein IIb/IIIa antagonists, anticoagulants, and statins.
April 2014: Cleveland Clinic Journal of Medicine
Eric P Cohen, Jean-Marie Krzesinski, Vincent Launay-Vacher, Ben Sprangers
No abstract text is available yet for this article.
November 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
(no author information available yet)
No abstract text is available yet for this article.
May 2015: Nephrology, Dialysis, Transplantation
Tobias Dreischulte, Daniel R Morales, Samira Bell, Bruce Guthrie
Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of acute kidney injury (AKI) when used in triple combination with renin-angiotensin system inhibitors and diuretics, but previous research reported that NSAIDs in dual combinations with either renin-angiotensin system inhibitors or diuretics alone were not. However, earlier studies relied on hospital coding to define AKI, which may underestimate true risk. This nested case-control study characterized the risk of community-acquired AKI associated with NSAID use among 78,379 users of renin-angiotensin system inhibitors and/or diuretics, where AKI was defined as a 50% or greater increase in creatinine from baseline...
August 2015: Kidney International
David Severs, Maarten B Rookmaaker, Ewout J Hoorn
Infusion fluids are often given to restore blood pressure (volume resuscitation), but may also be administered to replace ongoing losses, match insensible losses, correct electrolyte or acid-base disorders, or provide glucose. The development of new infusion fluids has provided clinicians with a wide range of products. Although the choice for a certain infusion fluid is often driven more by habit than by careful consideration, we believe it is useful to approach infusion fluids as drugs and consider their pharmacokinetic and pharmacodynamic characteristics...
July 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Luigi Gnudi, Janaka Karalliedde
Diabetic kidney disease represents a considerable burden; around one-third of patients with type 2 diabetes develop chronic kidney disease. In health, the kidneys play an important role in the regulation of glucose homeostasis via glucose utilization, gluconeogenesis and glucose reabsorption. In patients with diabetes, renal glucose homeostasis is significantly altered with an increase in both gluconeogenesis and renal tubular reabsorption of glucose. Environmental factors, both metabolic (hyperglycaemia, obesity and dyslipidaemia) and haemodynamic, together with a genetic susceptibility, lead to the activation of pro-oxidative, pro-inflammatory and pro-fibrotic pathways resulting in kidney damage...
July 2016: Nephrology, Dialysis, Transplantation
Ling Zhang, Jiqiao Yang, Glenn M Eastwood, Guijun Zhu, Aiko Tanaka, Rinaldo Bellomo
BACKGROUND: Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. STUDY DESIGN: A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). SETTING & POPULATION: Patients with acute kidney injury...
August 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Steve K Harris, Andrew J P Lewington, David A Harrison, Kathy M Rowan
We report the stepwise application of the RIFLE classification in 155,624 admissions in the UK Intensive Care National Audit & Research Centre Case Mix Programme database. The assumptions required to define RIFLE and their relationship with renal replacement therapy (RRT) and ICU mortality were assessed. Previous reports had not explored the method of estimating baseline creatinine, the position of class boundaries, or interactions between urine volume (AKI-U) and the peak/estimated baseline creatinine (AKI-Cr) within 24 h of ICU admission...
August 2015: Kidney International
Andrea M Pakula, Ruby A Skinner
PURPOSE: A comprehensive review of the literature to provide a focused and thorough update on the issue of acute kidney injury (AKI) in the surgical patient. METHODS: A PubMed and Medline search was performed and keywords included AKI, renal failure, critically ill, and renal replacement therapy (RRT). PRINCIPAL FINDINGS: A common clinical problem encountered in critically ill patients is AKI. The recent consensus definitions for the diagnosis and classification of AKI (ie, Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease/Acute Kidney Injury Network) have enabled us to standardize the severity of AKI and facilitate strategies for prevention...
June 2016: Journal of Intensive Care Medicine
Georg Schlieper, Katharina Hess, Jürgen Floege, Nikolaus Marx
Patients with chronic kidney disease (CKD) exhibit an increased cardiovascular risk. The high susceptibility to cardiovascular disease renders CKD patients 'vulnerable patients'. The overall cardiovascular risk of a vulnerable patient with CKD is determined by the components of the vulnerable myocardium, the vulnerable vessel and the vulnerable blood which in sum contribute to the increased morbidity and mortality risk in CKD patients. Future therapeutic strategies to reduce cardiovascular morbidity and mortality in this high-risk population should address all three aspects of vulnerability in CKD patients...
March 2016: Nephrology, Dialysis, Transplantation
Neill Y Li, Liping Tong, Andrew S Barbas, Syamal D Bhattacharya, Philip Y Wai, Paul C Kuo
No abstract text is available yet for this article.
March 2015: Transplantation
Anuja P Shah, Kamyar Kalantar-Zadeh, Joel D Kopple
Ketoacid (KA) analogues of essential amino acids (EAAs) provide several potential advantages for people with advanced chronic kidney disease (CKD). Because KAs lack the amino group bound to the α carbon of an amino acid, they can be converted to their respective amino acids without providing additional nitrogen. It has been well established that a diet with 0.3 to 0.4 g of protein per kilogram per day that is supplemented with KAs and EAAs reduces the generation of potentially toxic metabolic products, as well as the burden of potassium, phosphorus, and possibly sodium, while still providing calcium...
May 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Kamel S Kamel, Mitchell L Halperin
New England Journal of Medicine, Volume 372, Issue 6, Page 546-554, February 2015.
February 5, 2015: New England Journal of Medicine
Hassan Izzedine, Mark A Perazella
A bidirectional relationship has been observed for kidney disease and cancer. On the one hand, cancer is an important complication noted in kidney disease as well as a major cause of morbidity and mortality in this group. On the other hand, improved cancer treatment has prolonged survival, but also increased the development of acute and chronic kidney disease. The combination of cancer and kidney disease makes it challenging for clinicians to provide comprehensive and safe therapies for this group of patients...
December 2015: Nephrology, Dialysis, Transplantation
Claudine Angela Blum, Nicole Nigro, Matthias Briel, Philipp Schuetz, Elke Ullmer, Isabelle Suter-Widmer, Bettina Winzeler, Roland Bingisser, Hanno Elsaesser, Daniel Drozdov, Birsen Arici, Sandrine Andrea Urwyler, Julie Refardt, Philip Tarr, Sebastian Wirz, Robert Thomann, Christine Baumgartner, Hervé Duplain, Dieter Burki, Werner Zimmerli, Nicolas Rodondi, Beat Mueller, Mirjam Christ-Crain
BACKGROUND: Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia. METHODS: In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation...
April 18, 2015: Lancet
Djillali Annane
No abstract text is available yet for this article.
April 18, 2015: Lancet
Naykky Singh Ospina, Victor M Montori
No abstract text is available yet for this article.
January 20, 2015: Annals of Internal Medicine
Carole Dangoisse, Helen Dickie, Linda Tovey, Marlies Ostermann
BACKGROUND: Severe hyper- and hyponatraemia is associated with significant risks, yet its correction can also have serious consequences when implemented too fast or inadequately. The safe correction of serum sodium levels is particularly challenging when renal replacement therapy (RRT) is required. METHODS: Using 2 case scenarios, we aim to illustrate a simple method of correcting hyper- and hyponatraemia safely by step-wise manipulation of the dialysate/replacement fluid...
2014: Nephron. Clinical Practice
2015-04-21 21:38:55
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