2017 Apr - A risk prediction score for acute kidney injury in the intensive care unit

Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, Li G, Ohno-Machado L, Mehta R.; Nephrol Dial Transplant. 2017 Apr 10. doi: 10.1093/ndt/gfx026. [Epub ahead of print]

Background.: Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. Early identification of high-risk patients provides an opportunity to develop strategies for prevention, early diagnosis and treatment of AKI.

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2017 Feb - Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, Bittleman D, Cruz D, Endre Z, Fitzgerald RL, Forni L, Kane-Gill SL, Hoste E, Koyner J, Liu KD, Macedo E, Mehta R, Murray P, Nadim M, Ostermann M, Palevsky PM, Pannu N, Rosner M, Wald R, Zarbock A, Ronco C, Kellum JA; Acute Disease Quality Initiative Workgroup 16..; Nat Rev Nephrol. 2017 Feb 27.

Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD.

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2016 Aug - Pharmacokinetics and Pharmacodynamics of Extended Infusion Versus Short Infusion Piperacillin-Tazobactam in Critically Ill Patients Undergoing CRRT

Shotwell MS, Nesbitt R, Madonia PN, Gould ER, Connor MJ, Salem C, Aduroja OA, Amde M, Groszek JJ, Wei P, Taylor ME, Tolwani AJ, Fissell WH.; Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1377-83.

BACKGROUND AND OBJECTIVES: Infection is the most common cause of death in severe AKI, but many patients receiving continuous RRT do not reach target antibiotic concentrations in plasma. Extended infusion of β-lactams is associated with improved target attainment in critically ill patients; thus, we hypothesized that extended infusion piperacillin-tazobactam would improve piperacillin target attainment compared with short infusion in patients receiving continuous RRT.

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2016 Aug - Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

Mc Causland FR, Asafu-Adjei J, Betensky RA, Palevsky PM, Waikar SS.; Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1335-42.

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.

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2016 Apr - Prevention of contrast-induced nephropathy with single bolus erythropoietin in patients with diabetic kidney disease: A randomized controlled trial

Shema-Didi L, Kristal B, Eizenberg S, Marzuq N, Sussan M, Feldman-Idov Y, Ofir P, Atar S.; Nephrology (Carlton). 2016 Apr;21(4):295-300.

AIM: Contrast-induced-nephropathy (CIN) is associated with poor outcomes, thus prevention of CIN may be of clinical value. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in experimental models and in clinical studies of acute kidney injury. We therefore evaluated its effectiveness for prevention of CIN after coronary angiography (CA) ± percutaneous coronary intervention (PCI) in diabetic patients with chronic kidney disease.

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2016 Mar - Septic acute kidney injury in critically ill patients - a single-center study on its incidence, clinical characteristics, and outcome predictors

Shum HP, Kong HH, Chan KC, Yan WW, Chan TM.; Ren Fail. 2016 Mar 16:1-11. [Epub ahead of print]

Purpose: The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI.

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2015 Sep - Remote ischemic pre-conditioning for the prevention of acute kidney injury

Ho PW, Pang WF, Szeto CC.; Nephrology (Carlton). 2015 Sep 15.

Acute kidney injury (AKI) is a common complication associated with high morbidity and mortality in hospitalized patients. One potential mechanism underlying renal injury is ischemia/reperfusion injury (IRI), which attributed the organ damage to the inflammatory and oxidative stress responses induced by a period of renal ischemia and subsequent reperfusion.

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2015 Aug - Biomarker Enhanced Risk Prediction for Adverse Outcomes in Critically Ill Patients Receiving RRT

Pike F, Murugan R, Keener C, Palevsky PM, Vijayan A, Unruh M, Finkel K, Wen X, Kellum JA; Biological Markers for Recovery of Kidney (BioMaRK) Study Investigators.; Clin J Am Soc Nephrol. 2015 Aug 7;10(8):1332-9. doi: 10.2215/CJN.09911014. Epub 2015 Jun 5.

BACKGROUND AND OBJECTIVES: Higher plasma concentrations of inflammatory and apoptosis markers in critically ill patients receiving RRT are associated with RRT dependence and death. This study objective was to examine whether plasma inflammatory (IL-6, -8, -10, and -18; macrophage migration inhibitory factor) and apoptosis (death receptor-5, tumor necrosis factor receptor I and II) biomarkers augment risk prediction of renal recovery and mortality compared with clinical models.

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2015 Jan - Predictive value of plasma neutrophil gelatinase-associated lipocalin for acute kidney injury in ICU patients after major non-cardiac surgery

Shum HP, Leung NY, Chang LL, Tam OY, Kwan AM, Chan KC, Yan WW, Chan TM.: Nephrology (Carlton). 2015 Jan 20. doi: 10.1111/nep.12400. [Epub ahead of print]

PURPOSE: The performance of plasma Neutrophil gelatinase-associated lipocalin (pNGAL) for prediction of acute kidney injury (AKI) in non-cardiac surgical patients has not been well described. This study investigates the use of pNGAL for early detection of AKI in patients who were admitted to intensive care unit (ICU) after major or ultra-major non-cardiac surgery.

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2014 Sep - The Ethics of Offering Dialysis for AKI to the Older Patient: Time to Re-Evaluate?

Akbar S, Moss AH.; Clin J Am Soc Nephrol. 2014 Sep 5;9(9):1652-6.

Older patients are more susceptible to AKI. In the elderly, AKI has been associated with increased morbidity and mortality, and it is a significant risk factor for CKD and dialysis-dependent ESRD. There are now accumulating data that the start of dialysis for some older patients is associated with poor outcomes, such as high treatment intensity, suffering, and limited life prolongation, which occur at the expense of dignity and quality of life....

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2014 Jul - A Stepwise Approach for the Management of Poisoning with Extracorporeal Treatments

Ghannoum M, Roberts DM, Hoffman RS, Ouellet G, Roy L, Decker BS, Bouchard J.; Semin Dial. 2014 Jul;27(4):362-70.

The use of an extracorporeal treatment (ECTR) in a poisoned patient may be life-saving in a limited number of scenarios. The decision-processes surrounding the use of ECTR in poisoning is complex: most nephrologists are not trained to assess a poisoned patient while clinical toxicologists rarely prescribe ECTRs. Deciding on which ECTR is most appropriate for a poison requires a good understanding of the poison's physicochemical and pharmacokinetic properties. Further, a detailed understanding of the capabilities and limitations of the different ECTRs can be useful to select the most appropriate ECTR for a given clinical situation. This manuscript provides a stepwise approach to assess the usefulness of ECTRs in poisoning.

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2014 Jul - Principles and Operational Parameters to Optimize Poison Removal with Extracorporeal Treatments

Bouchard J, Roberts DM, Roy L, Ouellet G, Decker BS, Mueller BA, Desmeules S, Ghannoum M.: Semin Dial. 2014 Jul;27(4):371-80.

A role for nephrologists in the management of a poisoned patient involves evaluating the indications for, and methods of, enhancing the elimination of a poison. Nephrologists are familiar with the various extracorporeal treatments (ECTRs) used in the management of impaired kidney function, and their respective advantages and disadvantages. However, these same skills and knowledge may not always be considered, or applicable, when prescribing ECTR for the treatment of a poisoned patient. Maximizing solute elimination is a key aim of such treatments, perhaps more so than in the treatment of uremia, because ECTR has the potential to reverse clinical toxicity and shorten the duration of poisoning. This manuscript reviews the various principles that govern poison elimination by ECTR (diffusion, convection, adsorption, and centrifugation) and how components of the ECTR can be adjusted to maximize clearance. Data supporting these recommendations will be presented, whenever available.

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2014 Jul - Available Extracorporeal Treatments for Poisoning: Overview and Limitations

Ouellet G, Bouchard J, Ghannoum M, Decker BS.: Semin Dial. 2014 Jul;27(4):342-9.

Poisoning is a significant public health problem. In severe cases, extracorporeal treatments (ECTRs) may be required to prevent or reverse major toxicity. Available ECTRs include intermittent hemodialysis, sustained low-efficiency dialysis, intermittent hemofiltration and hemodiafiltration, continuous renal replacement therapy, hemoperfusion, therapeutic plasma exchange, exchange transfusion, peritoneal dialysis, albumin dialysis, cerebrospinal fluid exchange, and extracorporeal life support. The aim of this article was to provide an overview of the technical aspects, as well as the potential indications and limitations of the different ECTRs used for poisoned patients.

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2014 Jul - Nephrotoxic Effects of Common and Emerging Drugs of Abuse

Pendergraft WF 3rd, Herlitz LC, Thornley-Brown D, Rosner M, Niles JL.; Clin J Am Soc Nephrol. 2014 Jul 17.

The kidneys can be injured in diverse ways by many drugs, both legal and illegal. Novel associations and descriptions of nephrotoxic effects of common and emerging drugs of abuse have appeared over the past several years. Anabolic androgenic steroids, illicitly used by athletes and others for decades to increase muscle mass and decrease body fat, are emerging as podocyte toxins given recent descriptions of severe forms of FSGS in long-term abusers...

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2014 May - Validation of the Kidney Disease Improving Global Outcomes Criteria for AKI and Comparison of Three Criteria in Hospitalized Patients

Fujii T, Uchino S, Takinami M, Bellomo R.; Clin J Am Soc Nephrol. 2014 May;9(5):848-54.

BACKGROUND AND OBJECTIVES: AKI is a major clinical problem and predictor of outcome in hospitalized patients. In 2013, the Kidney Disease: Improving Global Outcomes (KDIGO) group published the third consensus AKI definition and classification system after the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease (RIFLE) and the Acute Kidney Injury Network (AKIN) working group systems. It is unclear which system achieves optimal prognostication in hospital patients.

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2013 Nov - Fluid management for the prevention and attenuation of acute kidney injury

Prowle JR, Kirwan CJ, Bellomo R.; Nat Rev Nephrol. 2013 Nov 12.

In patients with acute kidney injury (AKI), optimization of systemic haemodynamics is central to the clinical management. However, considerable debate exists regarding the efficacy, nature, extent and duration of fluid resuscitation, particularly when the patient has undergone major surgery or is in septic shock...

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2013 Jul - Use of Peritoneal Dialysis in AKI: A Systematic Review

Chionh CY, Soni SS, Finkelstein FO, Ronco C, Cruz DN.; Clin J Am Soc Nephrol. 2013 Jul 5. [Epub ahead of print]

BACKGROUND AND OBJECTIVES: The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis.

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2013 Jul - Adverse Drug Events during AKI and Its Recovery

Cox ZL, McCoy AB, Matheny ME, Bhave G, Peterson NB, Siew ED, Lewis J, Danciu I, Bian A, Shintani A, Ikizler TA, Neal EB, Peterson JF.; Clin J Am Soc Nephrol. 2013 Jul;8(7):1070-1078.

Background and objectives: The impact of AKI on adverse drug events and therapeutic failures and the medication errors leading to these events have not been well described.

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2013 Jun - Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

Koyner JL, Parikh CR.; Clin J Am Soc Nephrol. 2013 Jun;8(6):1034-42.

AKI is a common and serious complication that is associated with several adverse outcomes in hospitalized patients. The past several years have seen a large number of multicenter investigations of biomarkers of AKI in the setting of cardiac surgery and critical illness. This review summarizes these biomarker results to identify applications for clinical use...

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2013 Feb - Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature

Vanmassenhove J, Vanholder R, Nagler E, Van Biesen W.; Nephrol Dial Transplant. 2013 Feb;28(2):254-73.
Background: Acute kidney injury (AKI) remains associated with high morbidity and mortality, despite progress in medical care. Although the RIFLE (Risk, Injury, Failure, Loss, End-Stage Kidney Disease) and AKIN (Acute Kidney Injury Network) criteria, based on serum creatinine and urine output, were a step forward in diagnosing AKI, a reliable tool to differentiate between true parenchymal and pre-renal azotaemia in clinical practice is still lacking. In the last decade, many papers on the use of new urinary and serum biomarkers for the diagnosis and prognostication of AKI have been published. Thus, the question arises which biomarker is a reliable differential diagnostic tool under which circumstances.

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