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ICU nephro

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40 papers 0 to 25 followers
https://www.readbyqxmd.com/read/27872830/bacteremia-in-hemodialysis-patients
#1
REVIEW
Masashi Suzuki, Nobuhiko Satoh, Motonobu Nakamura, Shoko Horita, George Seki, Kyoji Moriya
Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection...
November 6, 2016: World Journal of Nephrology
https://www.readbyqxmd.com/read/27853353/update-on-sepsis-associated-acute-kidney-injury-emerging-targeted-therapies
#2
REVIEW
James F Doyle, Lui G Forni
Sepsis-associated acute kidney injury (SA-AKI) is an independent predictor of increased mortality and morbidity. It is essential that further advances in the treatment of sepsis should prioritize targeted therapies in SA-AKI in order to improve these bleak outcomes. As yet, a unique therapy that effectively reduces the impact of acute kidney injury has not been demonstrated. However, the emergence of novel targeted therapies, perhaps in combination, has the possibility of significantly reducing the long-term sequelae of an episode of SA-AKI...
2016: Biologics: Targets & Therapy
https://www.readbyqxmd.com/read/27821627/a-randomized-controlled-trial-of-rituximab-in-iga-nephropathy-with-proteinuria-and-renal-dysfunction
#3
Richard A Lafayette, Pietro A Canetta, Brad H Rovin, Gerald B Appel, Jan Novak, Karl A Nath, Sanjeev Sethi, James A Tumlin, Kshama Mehta, Marie Hogan, Stephen Erickson, Bruce A Julian, Nelson Leung, Felicity T Enders, Rhubell Brown, Barbora Knoppova, Stacy Hall, Fernando C Fervenza
IgA nephropathy frequently leads to progressive CKD. Although interest surrounds use of immunosuppressive agents added to standard therapy, several recent studies have questioned efficacy of these agents. Depleting antibody-producing B cells potentially offers a new therapy. In this open label, multicenter study conducted over 1-year follow-up, we randomized 34 adult patients with biopsy-proven IgA nephropathy and proteinuria >1 g/d, maintained on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with well controlled BP and eGFR<90 ml/min per 1...
November 7, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27831511/diagnosis-treatment-and-prevention-of-hemodialysis-emergencies
#4
REVIEW
Manish Saha, Michael Allon
Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies...
November 9, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27811558/renal-protection-in-the-21st-century
#5
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: Among critically ill patients, acute kidney injury (AKI) is still a common and serious complication with a tremendous impact on short-term and long-term outcomes. The objective of this review is to discuss strategies for renal protection and prevention of AKI in ICU patients. RECENT FINDINGS: It is fundamental to identify patients at risk for AKI as soon as possible and as accurately as possible. In order to achieve these goals, translational approaches implementing new biomarkers have shown promising results...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27763922/why-are-patients-still-getting-and-dying-from-acute-kidney-injury
#6
John A Kellum
PURPOSE OF REVIEW: Acute kidney injury is common and is associated with increased morbidity and mortality. Rates of acute kidney injury in most settings remain high and in some settings are increasing. Moreover, outcomes associated with acute kidney injury remain relatively poor. This review focuses on recent advances in understanding of acute kidney injury and discusses possible interventions based on these advances. RECENT FINDINGS: Acute kidney injury is not a disease with a single etiology and clinical course but rather a loose collection of syndromes whose unifying phenotype is an acute loss of glomerular filtration...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27730284/quality-indicators-of-continuous-renal-replacement-therapy-crrt-care-in-critically-ill-patients-a-systematic-review
#7
Oleksa G Rewa, Pierre-Marc Villeneuve, Philippe Lachance, Dean T Eurich, Henry T Stelfox, R T Noel Gibney, Lisa Hartling, Robin Featherstone, Sean M Bagshaw
OBJECTIVES: Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients. DESIGN: A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources...
October 11, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27748663/fluid-resuscitation-for-acute-kidney-injury-an-empty-promise
#8
Scott C Watkins, Andrew D Shaw
PURPOSE OF REVIEW: The past decade has seen more advances in our understanding of fluid therapy than the preceding decades combined. What was once thought to be a relatively benign panacea is increasingly being recognized as a potent pharmacological and physiological intervention that may pose as much harm as benefit. RECENT FINDINGS: Recent studies have clearly indicated that the amount, type, and timing of fluid administration have profound effects on patient morbidity and outcomes...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27719676/nomenclature-for-renal-replacement-therapy-and-blood-purification-techniques-in-critically-ill-patients-practical-applications
#9
Gianluca Villa, Mauro Neri, Rinaldo Bellomo, Jorge Cerda, A Raffaele De Gaudio, Silvia De Rosa, Francesco Garzotto, Patrick M Honore, John Kellum, Anna Lorenzin, Didier Payen, Zaccaria Ricci, Sara Samoni, Jean-Louis Vincent, Julia Wendon, Marta Zaccaria, Claudio Ronco
This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients...
October 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27719682/nomenclature-for-renal-replacement-therapy-in-acute-kidney-injury-basic-principles
#10
Mauro Neri, Gianluca Villa, Francesco Garzotto, Sean Bagshaw, Rinaldo Bellomo, Jorge Cerda, Fiorenza Ferrari, Silvia Guggia, Michael Joannidis, John Kellum, Jeong Chul Kim, Ravindra L Mehta, Zaccaria Ricci, Alberto Trevisani, Silvio Marafon, William R Clark, Jean-Louis Vincent, Claudio Ronco
This article reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement therapy (RRT) currently utilized to manage acute kidney injury (AKI). This multidisciplinary consensus conference discusses common definitions, components, techniques, and operations of the machines and platforms used to deliver extracorporeal therapies, utilizing a "machine-centric" rather than a "patient-centric" approach. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, focusing on continuous renal replacement therapies (CRRT) which are utilized in the management of critically ill patients with AKI...
October 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27670788/acute-kidney-injury-2016-diagnosis-and-diagnostic-workup
#11
Marlies Ostermann, Michael Joannidis
Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. In this review, we outline the current definition of AKI and the potential pitfalls, and summarise the existing and future tools to investigate AKI in critically ill patients.
September 27, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27661757/sepsis-induced-acute-kidney-injury
#12
Hernando Gómez, John A Kellum
PURPOSE OF REVIEW: Sepsis is a common and frequently fatal condition in which mortality has been consistently linked to increasing organ dysfunction. For example, acute kidney injury (AKI) occurs in 40-50% of septic patients and increases mortality six to eight-fold. However, the mechanisms by which sepsis causes organ dysfunction are not well understood and hence current therapy remains reactive and nonspecific. RECENT FINDINGS: Recent studies have challenged the previous notion that organ dysfunction is solely secondary to hypoperfusion, by showing, for example, that AKI occurs in the setting of normal or increased renal blood flow; and that it is characterized not by acute tubular necrosis or apoptosis, but rather by heterogeneous areas of colocalized sluggish peritubular blood flow and tubular epithelial cell oxidative stress...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27661440/medication-induced-acute-kidney-injury
#13
Stuart L Goldstein
PURPOSE OF REVIEW: The present article will review the current state of our understanding of nephrotoxic medication-associated acute kidney injury (AKI) and provide strategies to reduce its impact. RECENT FINDINGS: Nephrotoxic medications contribute to a substantial proportion of AKI in hospitalized patients. The previous perspective of nephrotoxic medication-associated AKI as a nonmodifiable necessary evil of providing appropriate therapy to ill patients had led to an incomplete understanding of its epidemiology and provided little impetus to reduce its occurrence...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27659469/contrast-induced-acute-kidney-injury
#14
REVIEW
Peter A McCullough, James P Choi, Georges A Feghali, Jeffrey M Schussler, Robert M Stoler, Ravi C Vallabahn, Ankit Mehta
Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrast-induced acute kidney injury (CI-AKI) for a subgroup of patients at risk for this complication. There has been a consistent and graded signal of risk for associated outcomes including need for renal replacement therapy, rehospitalization, and death, according to the incidence and severity of CI-AKI...
September 27, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27618271/methemoglobinemia-caused-by-portable-dialysis-in-the-critically-ill
#15
Boris I Medarov, Suneet Pahwa, Stephanie Reed, Richard Blinkhorn, Neha Rane, Marc A Judson
OBJECTIVE: To evaluate the root cause of a series of methemoglobinemia cases in a medical ICU. RESULTS: We report a sentinel case of methemoglobinemia that was associated with dialysis sessions using a portable dialysis unit in our hospital. This led to the identification of four additional patients who developed methemoglobinemia while undergoing portable dialysis. We determined that these episodes were caused by inadequate clearance of chloramine from the tap water used for portable dialysis...
September 9, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27505178/initiation-time-of-renal-replacement-therapy-on-patients-with-acute-kidney-injury-a-systematic-review-and-meta-analysis-of-8179-participants
#16
Caixia Wang, Lin-Sheng Lv, Hui Huang, Jianqiang Guan, Zengchun Ye, Shaomin Li, Yanni Wang, Tanqi Lou, Xun Liu
The early initiation of renal replacement therapy has been recommended for patients with acute renal failure by some studies, but its effects on mortality and renal recovery are unknown. We conducted an updated meta-analysis to provide quantitative evaluations of the association between the early initiation of renal replacement therapy and mortality for patients with acute kidney injury. After applying inclusion/exclusion criteria, 51 studies, including 10 randomized controlled trials, with a total of 8179 patients were analyzed...
August 9, 2016: Nephrology
https://www.readbyqxmd.com/read/27481735/can-early-initiation-of-continuous-renal-replacement-therapy-improve-patient-survival-with-septic-acute-kidney-injury-when-enrolled-in-early-goal-directed-therapy
#17
Hyung Jung Oh, Min Hyung Kim, Jin Young Ahn, Nam Su Ku, Jung Tak Park, Sang Hoon Han, Jun Yong Choi, Seung Hyeok Han, Tae-Hyun Yoo, Young Goo Song, Shin-Wook Kang, June Myung Kim
PURPOSE: The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI). MATERIALS AND METHODS: An observational retrospective cohort study was conducted of 60 patients (>18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea...
October 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27480256/acute-kidney-injury-in-critically-ill-cancer-patients-an-update
#18
REVIEW
Norbert Lameire, Raymond Vanholder, Wim Van Biesen, Dominique Benoit
Patients with cancer represent a growing group among actual ICU admissions (up to 20 %). Due to their increased susceptibility to infectious and noninfectious complications related to the underlying cancer itself or its treatment, these patients frequently develop acute kidney injury (AKI). A wide variety of definitions for AKI are still used in the cancer literature, despite existing guidelines on definitions and staging of AKI. Alternative diagnostic investigations such as Cystatin C and urinary biomarkers are discussed briefly...
August 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27411777/the-high-risk-of-contrast-induced-nephropathy-in-patients-with-suspected-pulmonary-embolism-despite-three-different-prophylaxis-a-randomized-controlled-trial
#19
Suleyman Turedi, Erkan Erdem, Yunus Karaca, Ozgur Tatli, Aynur Sahin, Suha Turkmen, Abdulkadir Gunduz
STUDY OBJECTIVE: To compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO3) plus NS and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients. MATERIALS AND METHODS: This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups...
July 14, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27373891/acute-kidney-injury-short-term-and-long-term-effects
#20
REVIEW
James F Doyle, Lui G Forni
Acute kidney injury (AKI) is the most common cause of organ dysfunction in critically ill adults, with a single episode of AKI, regardless of stage, carrying a significant morbidity and mortality risk. Since the consensus on AKI nomenclature has been reached, data reflecting outcomes have become more apparent allowing investigation of both short- and long-term outcomes.Classically the short-term effects of AKI can be thought of as those reflecting an acute deterioration in renal function per se. However, the effects of AKI, especially with regard to distant organ function ("organ cross-talk"), are being elucidated as is the increased susceptibility to other conditions...
July 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
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