2011 Aug - Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury

Heung M, Wolfgram DF, Kommareddi M, Hu Y, Song PX, Ojo AO.; Nephrol Dial Transplant. 2011 Aug 19. [Epub ahead of print]
BACKGROUND: Patients with acute kidney injury (AKI) requiring initiation of renal replacement therapy (RRT) have poor short- and long-term outcomes, including the development of dialysis dependence. Currently, little is known about what factors may predict renal recovery in this population.

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2011 Sep - Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: single-center randomized clinical trial

Zhang P, Yang Y, Lv R, Zhang Y, Xie W, Chen JH.; Nephrol Dial Transplant. 2011 Sep 2. [Epub ahead of print]
Introduction. Acute kidney injury (AKI) is a major complication in patients with sepsis and is an independent predictor of mortality. However, the optimal intensity of renal replacement therapy for such patients is still controversial.

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2011 Sep - Solute clearance in CRRT: prescribed dose versus actual delivered dose

Lyndon WD, Wille KM, Tolwani AJ.; Nephrol Dial Transplant. 2011 Sep 5. [Epub ahead of print]
BACKGROUND: Substantial efforts have been made toward defining the dose threshold of continuous renal replacement therapy (CRRT) associated with improved survival in critically ill patients with acute kidney injury. Published studies have used prescribed effluent rates, expressed as total effluent volume (TEV) per weight and unit time (mL/kg/h), as a surrogate for dose. The purpose of this study was to compare differences in CRRT dose based on prescribed effluent rate, measured TEV and direct measurement of urea and creatinine clearance.

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2011 Aug - Critical care nephrology: management of acid-base disorders with CRRT

Cerdá J, Tolwani AJ, Warnock DG. ;Kidney Int. 2011 Aug 3. doi: 10.1038/ki.2011.243. [Epub ahead of print]
Normal acid–base homeostasis is severely challenged in the intensive care setting. In this review, we address acid–base disturbances, with a special focus on the use of continuous (rather than intermittent) extracorporeal technologies in critical ill patients with acute kidney injury. We consider hypercapnic acidosis and lactic acidosis as examples in which continuous modalities may have different roles and indications than the traditional intermittent approaches to renal replacement therapy.

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2011 Aug - The distant organ effects of acute kidney injury [Review]

Grams ME, Rabb H.;Kidney Int. 2011 Aug 3. doi: 10.1038/ki.2011.241. [Epub ahead of print]
Despite the availability of renal replacement therapy, acute kidney injury (AKI) is associated with high mortality and morbidity. In humans, it is difficult to determine whether AKI is a cause or consequence of excess morbidity. In animal models, however, it is increasingly clear that AKI induces distant organ dysfunction.

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2011 Aug - Continuous infusion of a standard combination solution in the management of hyperkalemia

Janjua HS, Mahan JD, Patel HP, Mentser M, Schwaderer AL.; Nephrol Dial Transplant. 2011 Aug;26(8):2503-8. Epub 2011 Jan 10.
Background. Hyperkalemia, due to its effect on cardiac conductivity, is a potentially life-threatening electrolyte abnormality. Multiple therapeutic agents may be used alone or in combination for its prompt management.

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2011 Jul - Predictors of acute kidney injury in septic shock patients: an observational cohort study

Plataki M, Kashani K, Cabello-Garza J, Maldonado F, Kashyap R, Kor DJ, Gajic O, Cartin-Ceba R.; Clin J Am Soc Nephrol. 2011 Jul;6(7):1744-51.
Background and objectives: Acute kidney injury (AKI) is a frequent complication in critically ill patients and sepsis is the most common contributing factor. We aimed to determine the risk factors associated with AKI development in patients with septic shock.

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2011 Mar - Withholding and withdrawing renal support in acute kidney injury

Claure-Del Granado R, Mehta RL.; Semin Dial. 2011 Mar;24(2):208-14
Management of critically ill patients with acute kidney injury (AKI) is mainly limited to supportive therapy, with dialysis as one of the main components. Whether or not to offer dialysis and when to withdraw dialysis is a one of the many choices physicians face in daily clinical practice.

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2011 May - Sepsis and Acute Kidney Injury

Zarjou A, Agarwal A.; J Am Soc Nephrol. 2011 May 12. [Epub ahead of print]
Sepsis is a severe and dysregulated inflammatory response to infection characterized by end-organ dysfunction distant from the primary site of infection. Development of acute kidney injury (AKI) during sepsis increases patient morbidity, predicts higher mortality, has a significant effect on multiple organ functions, is associated with an increased length of stay in the intensive care unit, and hence consumes considerable healthcare resources.

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2011 May - The safety and efficacy of a new anticoagulation strategy using selective in-circuit blood cooling during haemofiltration--an experimental study

Krouzecky A, Chvojka J, Sykora R, Radej J, Karvunidis T, Novak I, Hanzlikova J, Bultasova L, Ruzicka J, Petrankova Z, Matejovic M.; Nephrol Dial Transplant. 2011 May;26(5):1622-7. Epub 2010 Oct 8.
BACKGROUND:Selective in-circuit blood cooling was recently shown to be an effective anticoagulation strategy during short-term haemofiltration. The aim of this study was to examine the safety of this novel method and circuit life.

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2011 Mar - Antibiotic Dosing in Critically Ill Patients With Acute Kidney Injury

Nature Reviews Nephrology

Rachel F. Eyler, PharmD; Bruce A. Mueller, PharmD, FCCP

 

Abstract

A common cause of acute kidney injury (AKI) is sepsis, which makes appropriate dosing of antibiotics in these patients essential. Drug dosing in critically ill patients with AKI, however, can be complicated. Critical illness and AKI can both substantially alter pharmacokinetic parameters as compared with healthy individuals or patients with end-stage renal disease. Furthermore, drug pharmacokinetic parameters are highly variable within the critically ill population. The volume of distribution of hydrophilic agents can increase as a result of fluid overload and decreased binding of the drug to serum proteins, and antibiotic loading doses must be adjusted upwards to account for these changes. Although renal elimination of drugs is decreased in patients with AKI, residual renal function in conjunction with renal replacement therapies (RRTs) result in enhanced drug clearance, and maintenance doses must reflect this situation. Antibiotic dosing decisions should be individualized to take into account patient-related, RRT-related, and drug-related factors. Efforts must also be made to optimize the attainment of antibiotic pharmacodynamic goals in this population.


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2011 Feb - Do Bicarbonate-Based Solutions for Continuous Renal Replacement Therapy Offer Better Control of Metabolic Acidosis than Lactate-Containing Fluids

Agarwal B, Kovari F, Saha R, Shaw S, Davenport A.; Nephron Clin Pract. 2011 Feb 23;118(4):c392-c398. [Epub ahead of print]
Introduction: Evidence that bicarbonate haemofiltration and dialysate fluids are superior to lactate in patients with acute kidney injury treated by continuous renal replacement therapy (CRRT) remains controversial.

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2011 Feb - Prolonged catheter survival in patients with acute kidney injury on continuous renal replacement therapy using a less thrombogenic micropatterned polymer modification

Meier P, Meier R, Turini P, Friolet R, Blanc E.; Nephrol Dial Transplant. 2011 Feb;26(2):628-35.
BACKGROUND: Continuous renal replacement therapy (CRRT) has been increasingly used in critically ill patients with acute kidney injury (AKI). One of the major properties that likely influence the catheter lifespan includes its surface specificity. We hypothesized that the improvement of blood-surface interaction by a reactive polymer film coating might reduce thrombogenic events in the vascular access device and subsequently lead to prolonged catheter survival in this clinical setting.

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2011 Jan - Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial

Hetzel GR, Schmitz M, Wissing H, Ries W, Schott G, Heering PJ, Isgro F, Kribben A, Himmele R, Grabensee B, Rump LC.; Nephrol Dial Transplant. 2011 Jan;26(1):232-9.
Background. Continuous venovenous haemofiltration (CVVH) in the intensive care setting requires anticoagulation to prevent clotting of the extracorporeal circuit. Several protocols avoiding heparin and using regional citrate anticoagulation have been developed to diminish bleeding risks. However, data from randomized trials comparing citrate anticoagulation with systemic heparinization are very limited.

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2011 Jan - Intra-abdominal Hypertension and Abdominal Compartment Syndrome

De Waele JJ, De Laet I, Kirkpatrick AW, Hoste E.; Am J Kidney Dis. 2011 Jan;57(1):159-69.
Increased intra-abdominal pressure (IAP), also referred to as intra-abdominal hypertension (IAH), affects organ function in critically ill patients and may lead to abdominal compartment syndrome (ACS). Although initially described in surgical patients, IAH and ACS also occur in medical patients without abdominal conditions.

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2010 Nov - Warfarin dosing in patients with impaired kidney function

Limdi NA, Limdi MA, Cavallari L, Anderson AM, Crowley MR, Baird MF, Allon M, Beasley TM.; Am J Kidney Dis. 2010 Nov;56(5):823-31.
BACKGROUND:
In patients with kidney impairment, warfarin, a drug metabolized primarily by the cytochrome P-450 system, is initiated at similar doses and managed similarly as in the general medical population. Unfortunately, few data exist to guide dose adjustment in patients with decreased kidney function. Here, we determine the degree of warfarin dose reduction associated with kidney impairment and make recommendations for warfarin dosing.

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2010 Dec - Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery: a secondary analysis of 2 small randomized trials

Venugopal V, Laing CM, Ludman A, Yellon DM, Hausenloy D.; Am J Kidney Dis. 2010 Dec;56(6):1043-9.
BACKGROUND:
Novel treatment strategies are required to reduce the development of acute kidney injury (AKI) in patients undergoing cardiac surgery. In this respect, remote ischemic preconditioning (RIPC), a phenomenon in which transient nonlethal ischemia applied to an organ or tissue protects another organ or tissue from subsequent lethal ischemic injury, is a potential renoprotective strategy.

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2010 Aug - Urinary Biomarkers in the Clinical Prognosis and Early Detection of Acute Kidney Injury

Koyner JL, Vaidya VS, Bennett MR, Ma Q, Worcester EM, Akhter SA, Raman J, Jeevanandam V, O'Connor MF, Devarajan P, Bonventre JV, Murray PT.; Clin J Am Soc Nephrol. 2010 Aug 26.
BACKGROUND AND OBJECTIVES:
Several novel urinary biomarkers have shown promise in the early detection and diagnostic evaluation of acute kidney injury (AKI). Clinicians have limited tools to determine which patients will progress to more severe forms of AKI at the time of serum creatinine increase. The diagnostic and prognostic utility of novel and traditional AKI biomarkers was evaluated during a prospective study of 123 adults undergoing cardiac surgery.

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2010 Aug - Urinary Biomarkers in the Clinical Prognosis and Early Detection of Acute Kidney Injury

Koyner JL, Vaidya VS, Bennett MR, Ma Q, Worcester EM, Akhter SA, Raman J, Jeevanandam V, O'Connor MF, Devarajan P, Bonventre JV, Murray PT.; Clin J Am Soc Nephrol. 2010 Aug 26.
BACKGROUND AND OBJECTIVES:
Several novel urinary biomarkers have shown promise in the early detection and diagnostic evaluation of acute kidney injury (AKI). Clinicians have limited tools to determine which patients will progress to more severe forms of AKI at the time of serum creatinine increase. The diagnostic and prognostic utility of novel and traditional AKI biomarkers was evaluated during a prospective study of 123 adults undergoing cardiac surgery.

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2009 Dec 3 - 2010 Ultrasound-Guided Femoral Dialysis Access Placement: A Single-Center Randomized Trial

Mayoor V. Prabhu*, Deven Juneja, Palepu B. Gopal, Mohan Sathyanarayanan, Sreepada Subhramanyam*, Sridhar Gandhe*, and k. Shivanand Nayak*. Clin J Am Soc Nephrol 5: 235-239, 2010. Published ahead of print on December 3, 2009
Background and objectives: Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmark-guided technique (ALT) for the femoral vein (FV).

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