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Alasfar S, Koubar SH, Gautam SC, Jaar BG. Kidney Care in Times of Crises: A Review. Am J Kidney Dis 2024:S0272-6386(24)00789-3. [PMID: 38851445 DOI: 10.1053/j.ajkd.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/10/2024]
Abstract
The global burden of kidney disease is increasing, paralleled by a rising number of natural and man-made crises. During these tumultuous times, accessing vital healthcare resources becomes challenging, posing significant risks to individuals, particularly those with kidney disease. This review delves into the impact of crises on kidney disease, with a particular focus on acute kidney injury (AKI), kidney failure (KF), and kidney transplant (KT). Patients experiencing crush injuries leading to AKI may encounter delayed diagnosis due to the chaotic nature of disasters and limited availability of resources. In chronic crises, such as conflicts, patients with KF are particularly affected, and deviations from dialysis standards are unfortunately common, impacting morbidity and mortality rates. Additionally, crises also disrupt access to kidney transplants, potentially compromising transplant outcomes. This review underscores the critical importance of preparedness measures and proactive management for kidney disease in crisis settings. Collaborative efforts among government bodies, rescue teams, healthcare providers, humanitarian agencies, and nongovernmental organizations are imperative to ensure equitable and reasonable care for kidney disease patients during times of crises, with the aim of saving lives and improving outcomes.
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Affiliation(s)
- Sami Alasfar
- Department of Medicine, Division of Nephrology, Mayo Clinic, Phoenix, Arizona
| | - Sahar H Koubar
- Department of Medicine, Division of Nephrology, University of Minnesota, Minneapolis, Minnesota
| | - Samir C Gautam
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland.
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2
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Figueiredo AE, Hurst H, Neumann JL, Chow JSF, Walker R, Woodhouse J, Punzalan S, Tomlins M, Cave K, Brunier G. Nursing management of catheter-related non-infectious complications of PD: Your questions answered. Perit Dial Int 2024:8968608241246449. [PMID: 38770907 DOI: 10.1177/08968608241246449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.
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Affiliation(s)
- Ana E Figueiredo
- Curso de Enfermagem, Escola de Ciência da Sáude e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Helen Hurst
- School of Health and Society, University of Salford, UK
| | | | | | - Rachael Walker
- University of Auckland, New Zealand and Hawke's Bay District Health Board, Hastings, New Zealand
| | - Jayne Woodhouse
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Melinda Tomlins
- John Hunter Hospital, Hunter New England Local Health District, NSW, Australia
| | - Katie Cave
- Peritoneal Dialysis Unit, Abbotsford Regional Hospital and Cancer Centre, Fraser Health, BC, Canada
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3
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Javaid MM, Ekladious A, Khan BA. Is It Time to Give Peritoneal Dialysis Its Due Place in Managing Acute Kidney Injury: Lessons Learnt from COVID-19 Pandemic. Blood Purif 2023; 53:71-79. [PMID: 37980897 PMCID: PMC10836743 DOI: 10.1159/000535243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
Despite comparable outcomes with the extracorporeal dialysis modalities, peritoneal dialysis (PD) is seldom considered a viable option for managing acute kidney injury (AKI) in developed and resource-rich countries, where continuous renal replacement therapies (CRRTs) are the mainstay of treating AKI. PD has fewer infrastructure requirements and has been shown to save lives during conflicts, natural disasters, and pandemics. During the ongoing COVID-19 pandemic, the developed world was confronted with a sudden surge in critically ill AKI patients requiring renal replacement therapy. There were acute shortages of CRRT machines and the trained staff to deliver those treatments. Some centres developed acute PD programmes to circumvent these issues with good results. This experience re-emphasised the suitability of PD for managing AKI. It also highlighted the need to review the current management strategies for AKI in developed countries and consider incorporating PD as a viable tool for suitable patients. This article reviews the current evidence of using PD in AKI, attempts to clarify some misconceptions about PD in AKI, and argues in favour of developing acute PD programmes.
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Affiliation(s)
- Muhammad M Javaid
- Monash Rural Health Mildura, Monash University, Melbourne, Victoria, Australia
- Department of Renal Medicine, Woodlands Health, Singapore, Singapore
- Clinical School, Deakin University, Melbourne, Victoria, Australia
| | - Adel Ekladious
- Department of Medicine and Acute Assessment Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
- Faculty of Health and Medical Science, University of Western Australia, Perth, Washington, Australia
| | - Behram A Khan
- School of Medicine, National University of Singapore, Singapore, Singapore
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4
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Ramírez-Guerrero G, Husain-Syed F, Ponce D, Torres-Cifuentes V, Ronco C. Peritoneal dialysis and acute kidney injury in acute brain injury patients. Semin Dial 2023; 36:448-453. [PMID: 36913952 DOI: 10.1111/sdi.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/21/2023] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
Acute kidney injury (AKI) is a heterogeneous syndrome with multiple etiologies. It occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. In this scenario, AKI alters the kidney-brain axis, exposing patients who receive habitual dialytic management to greater injury. Various therapies have been designed to mitigate this risk. Priority has been placed by KDIGO guidelines on the use of continuous over intermittent acute kidney replacement therapies (AKRT). On this background, continuous therapies have a pathophysiological rationale in patients with acute brain injury. A low-efficiency therapy such as PD and CRRT could achieve optimal clearance control and potentially reduce the risk of secondary brain injury. Therefore, this work will review the evidence on peritoneal dialysis as a continuous AKRT in neurocritical patients, describing its benefits and risks so it may be considered as an option when deciding among available therapeutic options.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Faeq Husain-Syed
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
| | - Daniela Ponce
- Department of Internal Medicine, University Hospital, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Vicente Torres-Cifuentes
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza, Vicenza, Italy
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5
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Pethő ÁG, Tapolyai M, Browne M, Fülöp T, Orosz P, Szabó RP. The Importance of the Nephrologist in the Treatment of the Diuretic-Resistant Heart Failure. Life (Basel) 2023; 13:1328. [PMID: 37374112 PMCID: PMC10303045 DOI: 10.3390/life13061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Heart failure is not only a global problem but also significantly limits the life prospects of these patients. The epidemiology and presentation of heart failure are intensively researched topics in cardiology. The risk factors leading to heart failure are well known; however, the real challenge is to provide effective treatments. A vicious cycle develops in heart failure of all etiologies, sooner or later compromising both cardiac and kidney functions simultaneously. This can explain the repeated hospital admissions due to decompensation and the significantly reduced quality of life. Moreover, diuretic-refractory heart failure represents a distinct challenge due to repeated hospital admissions and increased mortality. In our narrative review, we wanted to draw attention to nephrology treatment options for severe diuretic-resistant heart failure. The incremental value of peritoneal dialysis in severe heart failure and the feasibility of percutaneous peritoneal dialysis catheter insertion have been well known for many years. In contrast, the science and narrative of acute peritoneal dialysis in diuretic-resistant heart failure remains underrepresented. We believe that nephrologists are uniquely positioned to help these patients by providing acute peritoneal dialysis to reduce hospitalization dependency and increase their quality of life.
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Affiliation(s)
- Ákos Géza Pethő
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Mihály Tapolyai
- Department of Nephrology, Szent Margit Kórhaz, 1032 Budapest, Hungary
- Medicine Service, Ralph H. Jonson VA Medical Center, Charleston, SC 29401, USA
| | - Maria Browne
- Department of Medicine, Division of Nephrology, University of Maryland Medical Center, Baltimore, MD 21201, USA
- Medicine Service, Baltimore VA Medical Center, Baltimore, MD 21201, USA
| | - Tibor Fülöp
- Medicine Service, Ralph H. Jonson VA Medical Center, Charleston, SC 29401, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Petronella Orosz
- Bethesda Children's Hospital, 1146 Budapest, Hungary
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Réka P Szabó
- Department of Nephrology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Al Sahlawi M, Ponce D, Charytan DM, Cullis B, Perl J. Peritoneal Dialysis in Critically Ill Patients: Time for a Critical Reevaluation? Clin J Am Soc Nephrol 2023; 18:512-520. [PMID: 36754063 PMCID: PMC10103328 DOI: 10.2215/cjn.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peritoneal dialysis (PD) as an AKI treatment in adults was widely accepted in critical care settings well into the 1980s. The advent of extracorporeal continuous KRT led to widespread decline in the use of PD for AKI across high-income countries. The lack of familiarity and comfort with the use of PD in critical care settings has also led to lack of use even among those receiving maintenance PD. Many critical care units reflexively convert patients receiving maintenance PD to alternative dialysis therapies at admission. Renewed interest in the use of PD for AKI therapy has emerged due to its increasing use in low- and middle-income countries. In high-income countries, the coronavirus disease 2019 (COVID-19) pandemic, saw PD for AKI used early on, where many critical care units were in crisis and relied on PD use when resources for other AKI therapy modalities were limited. In this review, we highlight advantages and disadvantages of PD in critical care settings and indications and contraindications for its use. We provide an overview of literature to support both PD treatment during AKI and its continuation as a maintenance therapy during critical illness. For AKI therapy, we further discuss establishment of PD access, PD prescription management, and complication monitoring and treatment. Finally, we discuss expansion in the use of PD for AKI therapy extending beyond its role during times of resource constraints.
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Affiliation(s)
- Muthana Al Sahlawi
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | - Daniela Ponce
- Department of Medicine, Botukatu School of Medicine, Sao Paulo, Brazil
| | - David M. Charytan
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Brett Cullis
- Renal and Intensive Care Unit, Hilton Life Hospital, Cape Town, South Africa
- Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Cullis B. Peritoneal dialysis for acute kidney injury: back on the front-line. Clin Kidney J 2022; 16:210-217. [PMID: 36755845 PMCID: PMC9900590 DOI: 10.1093/ckj/sfac201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 11/12/2022] Open
Abstract
Peritoneal dialysis (PD) for acute kidney injury (AKI) has been available for nearly 80 years and has been through periods of use and disuse largely determined by availability of other modalities of kidney replacement therapy and the relative enthusiasm of clinicians. In the past 10 years there has been a resurgence in the use of acute PD globally, facilitated by promotion of PD for AKI in lower resource countries by nephrology organizations effected through the Saving Young Lives program and collaborations with the World Health Organisation, the development of guidelines standardizing prescribing practices and finally the COVID-19 pandemic. This review highlights the history of PD for AKI and looks at misconceptions about efficacy as well as the available evidence demonstrating that acute PD is a safe and lifesaving therapy with comparable outcomes to other modalities of treatment.
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Atlani MK, Pilania RK, Bhatt GC. Outcomes following peritoneal dialysis for COVID-19-induced AKI: A literature review. Perit Dial Int 2022; 42:554-561. [PMID: 35938619 DOI: 10.1177/08968608221115000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute kidney injury (AKI) has been shown to be associated with significant morbidity and mortality in patients with severe COVID-19 disease. Due to increasing number of cases in pandemic, there is a significant shortage of medical facilities and equipment in relation to patient load. In low resource settings where access to intermittent haemodialysis (HD) or continuous kidney replacement therapy (CKRT) is limited, peritoneal dialysis (PD) may play a vital role in the management of COVID-19-induced AKI. A literature search using Medline/PubMed, Embase, Google Scholar and Cochrane register was performed using following search strategy: (((COVID 19) OR (SARS-CoV-2)) AND (((acute kidney injury) OR (acute renal failure)) OR (acute renal dysfunction))) AND (peritoneal dialysis). Search strategy yielded total 79 articles. After going through titles and abstracts, full text of 15 articles was obtained. Finally, six studies were included in the review after exclusion of 10 studies. Five studies were single centre and one study was multicentric; four studies were conducted in the United States and one in the United Kingdom; PD catheter placement was done by surgeons in three studies and by nephrologist in one study. The mortality reported in the studies varied from 43% to as high as 63%.
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Affiliation(s)
| | - Rakesh Kumar Pilania
- Pediatric Allergy Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Sciences (PGIMER), Chandigarh
| | - Girish Chandra Bhatt
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Bhopal
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Abstract
Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.
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Affiliation(s)
- James Hilton
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Naomi Boyer
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK.
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, 3347 Forbes Avenue #220, Pittsburgh, PA 15213, USA
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Hausinger R, Schmaderer C, Heemann U, Bachmann Q. Innovationen in der Peritonealdialyse. DER NEPHROLOGE 2022; 17:85-91. [PMID: 34786026 PMCID: PMC8588934 DOI: 10.1007/s11560-021-00542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/03/2022]
Abstract
Die Peritonealdialyse (PD) war früher eine geläufige Behandlung beim akuten dialysepflichtigen Nierenversagen. Zugunsten kontinuierlicher, extrakorporaler Nierenersatzverfahren verschwand sie von der Bildfläche der westlichen Welt, wohingegen sie in strukturarmen Ländern aufgrund ihrer Simplizität und geringen Ressourcenintensität weiter eingesetzt wird. Die Engpässe in der medizinischen Versorgung im Rahmen der COVID-19(„coronavirus disease 2019“)-Pandemie führten kürzlich zu erneuter weltweiter Beachtung der PD als sichere Option beim akuten dialysepflichtigen Nierenversagen. Von der Einführung biokompatibler Lösungen vor 20 Jahren war eine Reduktion von Mortalität oder technischem Versagen erwartet worden. Leider konnten Studien dieses bisher allenfalls andeuten, nicht aber beweisen. Eine innovative Option stellen immunmodulatorische Adjuvanzien dar, die die lokale Immunkompetenz verbessern und den Verlust der Funktion des Peritoneums verhindern sollen. Derzeit rückt die Vision einer tragbaren künstlichen Niere immer näher. Auch eine Intensivierung der Dialysedosis erscheint mit minimaler Dialysatmenge erreichbar. In Zeiten der globalen Erderwärmung könnten durch die Regeneration von Dialysat nicht nur relevante Mengen an Wasser eingespart, sondern auch die CO2-Bilanz günstig beeinflusst werden. Zusammenfassend erlebt die PD derzeit einen zweiten Frühling. Dieser Artikel beschreibt die derzeitigen und zukünftigen Entwicklungen dieses Verfahrens.
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Samaan F, Carneiro de Paula E, de Lima Souza FBG, Mendes LFC, Rossi PRG, Freitas RAP, Nakagawa FT, Maciel AT, Aranha S, Osawa E, Konigsfeld HP, da Silva RG, de Souza RBC, Coutinho SM, Vieira TD, Thomaz KDB, Flato EMS, da Silva RC, Andrade LV, Badaoui M, Badaoui EP, Goes MÂ, do Amaral SH, Cunha K, Muniz IM, Sampaio JS, Durão Junior MDS, Zanetta DMT, Burdmann EA. COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil. PLoS One 2022; 17:e0261958. [PMID: 35030179 PMCID: PMC8759670 DOI: 10.1371/journal.pone.0261958] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. METHODS This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. RESULTS The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. CONCLUSION AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).
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Affiliation(s)
- Farid Samaan
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
- Nephrology Division, University of São Paulo Medical School, São Paulo, Brazil
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
- Planning and Evaluation Group, São Paulo State Health Department, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Sylvia Aranha
- Imed Research Group, São Camilo Pompeia Hospital, São Paulo, Brazil
| | - Eduardo Osawa
- Imed Research Group, São Camilo Pompeia Hospital, São Paulo, Brazil
| | - Henrique Pinheiro Konigsfeld
- Nephrology Division, Santa Cruz Hospital, São Paulo, Brazil
- Nephrology Division, Sepaco Hospital, São Paulo, Brazil
| | - Riberto Garcia da Silva
- Nephrology Division, Santa Cruz Hospital, São Paulo, Brazil
- Nephrology Division, Sepaco Hospital, São Paulo, Brazil
| | | | - Saurus Mayer Coutinho
- Nephrology Division, Santa Cruz Hospital, São Paulo, Brazil
- Nephrology Division, Sepaco Hospital, São Paulo, Brazil
| | - Tales Dantas Vieira
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
- Nephrology Division, Cruzeiro do Sul Hospital, Osasco, São Paulo, Brazil
| | | | | | | | - Lucas Vicente Andrade
- Department of General Surgery, Ipiranga Hospital Care Management Unit, São Paulo, Brazil
| | - Muna Badaoui
- Nephrology Division, University of São Paulo Medical School, São Paulo, Brazil
- Nephrology Division, Vila Nova Brasilândia Hospital, São Paulo, Brazil
| | - Eduardo Pogetti Badaoui
- Nephrology Division, University of São Paulo Medical School, São Paulo, Brazil
- Nephrology Division, Vila Nova Brasilândia Hospital, São Paulo, Brazil
| | - Miguel Ângelo Goes
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Henrique do Amaral
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
- Medical Board, Bosque da Saúde Hospital, São Paulo, Brazil
| | - Karlla Cunha
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
- Medical Board, Bosque da Saúde Hospital, São Paulo, Brazil
| | - Inês Marin Muniz
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
| | - Jacqueline Siqueira Sampaio
- Department of High Complexity Patients, Grupo NotreDame Intermédica, São Paulo, Brazil
- Medical Board, Intermédica Guarulhos Hospital, Guarulhos, São Paulo, Brazil
| | - Marcelino de Souza Durão Junior
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
- Nephrology Division, São Paulo Hospital, São Paulo, Brazil
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12
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Cottam D, Nadim MK, Forni LG. Management of acute kidney injury associated with Covid-19: what have we learned? Curr Opin Nephrol Hypertens 2021; 30:563-570. [PMID: 34535006 DOI: 10.1097/mnh.0000000000000742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Although initially kidney involvement in COVID-19 infection was felt to occur relatively infrequently, this has proved not to be the case. In critically ill patients with COVID-19, multiorgan failure including acute kidney injury (AKI) is common and is associated with an increased risk of mortality and morbidity. This review focuses briefly on the epidemiology and pathophysiology of COVID-19 associated AKI as well as options for management. RECENT FINDINGS The risk factors for AKI are common to both noncovid-related AKI and COVID-19 associated AKI. Kidney injury in COVID-19 associated AKI may arise through several mechanisms, including not only direct effects on the kidney leading to tubular injury but also through the effects of treatment of multiorgan failure complicating infection. During surge conditions, the use of kidney replacement therapy has embraced all modalities including the use of peritoneal dialysis. The use of blood purification techniques has been proposed, but to date, the results are variable. SUMMARY COVID-19 associated AKI is common, affecting approximately a quarter of patients hospitalized with COVID-19. Glomerular injury can occur, but in the main tubular injury seems most likely leading to AKI, which should be managed following clinical pathways informed by accepted guidelines.
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Affiliation(s)
- Daniel Cottam
- Department of Critical Care, Royal Surrey Hospital, Surrey, UK
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital, Surrey, UK
- Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Surrey, UK
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Jewell PD, Bramham K, Galloway J, Post F, Norton S, Teo J, Fisher R, Saha R, Hutchings S, Hopkins P, Smith P, Joslin J, Jayawardene S, Mackie S, Mudhaffer A, Holloway A, Kibble H, Akter M, Zuckerman B, Palmer K, Murphy C, Iatropoulou D, Sharpe CC, Lioudaki E. COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort. BMC Nephrol 2021; 22:359. [PMID: 34719384 PMCID: PMC8557997 DOI: 10.1186/s12882-021-02557-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/27/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre. METHODS We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020. RESULTS Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24-4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27-2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19-2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82-4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17-4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months. CONCLUSIONS This large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3-6 months.
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Affiliation(s)
- Paul D Jewell
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Kate Bramham
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - James Galloway
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Centre for Rheumatic Disease, King's College London, London, UK
| | - Frank Post
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Sam Norton
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - James Teo
- Department of Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
| | - Richard Fisher
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Rohit Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sam Hutchings
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Phil Hopkins
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Priscilla Smith
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Jennifer Joslin
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Satish Jayawardene
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Sarah Mackie
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Ali Mudhaffer
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Amelia Holloway
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Henry Kibble
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Mosammat Akter
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Benjamin Zuckerman
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Kieran Palmer
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Ciara Murphy
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Domniki Iatropoulou
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Claire C Sharpe
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Eirini Lioudaki
- Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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Ponce D, Zamoner W, Dias DB, Pires da Rocha E, Kojima C, Balbi AL. The Role of Peritoneal Dialysis in the Treatment of Acute Kidney Injury in Patients With Acute-on-Chronic Liver Failure: A Prospective Brazilian Study. Front Med (Lausanne) 2021; 8:713160. [PMID: 34631735 PMCID: PMC8496932 DOI: 10.3389/fmed.2021.713160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to explore the role of peritoneal dialysis (PD) in acute-on-chronic liver disease (ACLD) in relation to metabolic and fluid control and outcome. Fifty-three patients were treated by PD (prescribed Kt/V = 0.40/session), with a flexible catheter, tidal modality, using a cycler and lactate as a buffer. The mean age was 64.8 ± 13.4 years, model of end stage liver disease (MELD) was 31 ± 6, 58.5% were in the intensive care unit, 58.5% needed intravenous inotropic agents including terlipressin, 69.5% were on mechanical ventilation, alcoholic liver disease was the main cause of cirrhosis and the main dialysis indications were uremia and hypervolemia. Blood urea and creatinine levels stabilized after four sessions at around 50 and 2.5 mg/dL, respectively. Negative fluid balance (FB) and ultrafiltration (UF) increased progressively and stabilized around 3.0 L and -2.7 L/day, respectively. Weekly-delivered Kt/V was 2.7 ± 0.37, and 71.7% of patients died. Five factors met the criteria for inclusion in the multivariable analysis. Logistic regression identified as risk factors associated with Acute Kidney Injury (AKI) in ACLD patients: MELD (OR = 1.14, CI 95% = 1.09-2.16, p = 0.001), nephrotoxic AKI (OR = 0.79, CI 95% = 0.61-0.93, p = 0.02), mechanical ventilation (OR = 1.49, CI 95% = 1.14-2.97, p < 0.001), and positive fluid balance (FB) after two PD sessions (OR = 1.08, CI 95% = 1.03-1.91, p = 0.007). These factors were significantly associated with death. In conclusion, our study suggests that careful prescription may contribute to providing adequate treatment for most Acute-on-Chronic Liver Failure (ACLF) patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious or mechanical complications. MELD, mechanical complications and FB were factors associated with mortality, while nephrotoxic AKI was a protective factor. Further studies are needed to better investigate the role of PD in ACLF patients with AKI.
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Affiliation(s)
- Daniela Ponce
- Department of Internal Medicine, Botucatu Medical School – University of São Paulo State – UNESP, São Paulo, Brazil
| | - Welder Zamoner
- Botucatu Medical School – University of São Paulo State – UNESP, São Paulo, Brazil
| | | | - Erica Pires da Rocha
- Botucatu Medical School – University of São Paulo State – UNESP, São Paulo, Brazil
| | - Christiane Kojima
- Botucatu Medical School – University of São Paulo State – UNESP, São Paulo, Brazil
| | - André Luís Balbi
- Department of Internal Medicine, Botucatu Medical School – University of São Paulo State – UNESP, São Paulo, Brazil
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Abu-Rub LI, Abdelrahman HA, Johar ARA, Alhussain HA, Hadi HA, Eltai NO. Antibiotics Prescribing in Intensive Care Settings during the COVID-19 Era: A Systematic Review. Antibiotics (Basel) 2021; 10:935. [PMID: 34438985 PMCID: PMC8389042 DOI: 10.3390/antibiotics10080935] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
The prevalence of patients admitted to intensive care units (ICUs) with SARS-CoV-2 infection who were prescribed antibiotics is undetermined and might contribute to the increased global antibiotic resistance. This systematic review evaluates the prevalence of antibiotic prescribing in patients admitted to ICUs with SARS-CoV-2 infection using PRISMA guidelines. We searched and scrutinized results from PubMed and ScienceDirect databases for published literature restricted to the English language up to 11 May 2021. In addition, we included observational studies of humans with laboratory-confirmed SARS-CoV-2 infection, clinical characteristics, and antibiotics prescribed for ICU patients with SARS-CoV-2 infections. A total of 361 studies were identified, but only 38 were included in the final analysis. Antibiotic prescribing data were available from 2715 patients, of which prevalence of 71% was reported in old age patients with a mean age of 62.7 years. From the reported studies, third generation cephalosporin had the highest frequency amongst reviewed studies (36.8%) followed by azithromycin (34.2%). The estimated bacterial infection in 12 reported studies was 30.8% produced by 15 different bacterial species, and S. aureus recorded the highest bacterial infection (75%). The fundamental outcomes were the prevalence of ICU COVID-19 patients prescribed antibiotics stratified by age, type of antibiotics prescribed, and the presence of co-infections and comorbidities. In conclusion, more than half of ICU patients with SARS-CoV-2 infection received antibiotics, and prescribing is significantly higher than the estimated frequency of identified bacterial co-infection.
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Affiliation(s)
- Lubna I. Abu-Rub
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
| | - Hana A. Abdelrahman
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
| | | | - Hashim A. Alhussain
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
| | - Hamad Abdel Hadi
- Communicable Diseases Centre, Infectious Disease Division, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Nahla O. Eltai
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
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