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Yu L, Cheng S, Zhang M, Zhou T, Chen Y, Zhang Z, Yu Y. Successful treatment of peritoneal dialysis for two patients with refractory nephrotic syndrome and acute kidney injury: a case report. Front Med (Lausanne) 2023; 10:1263780. [PMID: 37920598 PMCID: PMC10618994 DOI: 10.3389/fmed.2023.1263780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Two patients with refractory nephrotic syndrome were treated with peritoneal dialysis (PD) for diuretic resistance, anasarca and acute kidney injury. Following PD, their fluid overload was promptly alleviated, accompanied by an increase in urine volume and an improvement in renal function. PD as an adjuvant approach enabled them to resume corticosteroids and immunosuppressive agents. Eventually, both patients could be withdrawn from PD and achieved remission of proteinuria.
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Affiliation(s)
| | | | | | | | | | | | - Yusheng Yu
- National Clinical Research Center for Kidney Disease, Jinling Hospital, Nanjing, China
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Li Y, Zhang Y, Li R, Zhang M, Gao X. Timing of initiation of renal replacement therapy for patients with acute kidney injury: A meta-analysis of RCTs. Ther Apher Dial 2023; 27:207-221. [PMID: 36053938 DOI: 10.1111/1744-9987.13914] [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: 04/02/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the effects of delayed versus early renal replacement therapy (RRT) initiation for patients with AKI. METHODS Related RCTs of RRT initiated at different times published on PubMed, Web of Science, Embase, and Cochrane Library were searched. RESULTS Fifteen RCTs studies with 5395 patients were included. The results showed that the 28-day mortality (RR 1.01; 95% CI 0.94 ~ 1.08; p = 0.80), 60-day mortality (RR 1.00; 95% CI 0.91 ~ 1.11; p = 0.93), 90-day mortality (RR 1.01; 95% CI 0.94 ~ 1.08; p = 0.80), dialysis dependence among survivors (RR 0.67; 95% CI 0.40 ~ 1.13; p = 0.13), length of ICU stay (RR -1.32; 95% CI -3.26 ~ 0.62; p = 0.18) and length of hospital stay among survivors(RR -0.98; 95% CI -2.89 ~ 0.92; p = 0.31) were not significantly different between the two groups. In addition, early initiation of RRT increases the incidence of hypotension (RR 1.42, 95% CI 1.23 ~ 1.63; p < 0.00001) and infectious (RR 1.36; 95% CI 1.03 ~ 1.80; p = 0.03) events. CONCLUSION Early initiation of RRT cannot improve the prognosis and benefit patients.
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Affiliation(s)
- Yunjie Li
- School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Yong Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Rui Li
- Department of Critical Care Medicine, Chongqing Kaizhou District People's Hospital, Kaizhou, Chongqing, China
| | - Ming Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Xiang Gao
- Department of Critical Care Medicine, Weifang People's Hospital, Weifang, Shandong, China
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Sourial MY, Gone A, Uribarri J, Srivatana V, Sharma S, Shimonov D, Chang M, Mowrey W, Dalsan R, Sedaliu K, Jain S, Ross MJ, Caplin N, Chen W. Outcomes of PD for AKI treatment during COVID-19 in New York City: A multicenter study. Perit Dial Int 2023; 43:13-22. [PMID: 36320182 PMCID: PMC10115518 DOI: 10.1177/08968608221130559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The high incidence of acute kidney injury (AKI) requiring dialysis associated with COVID-19 led to the use of peritoneal dialysis (PD) for the treatment of AKI. This study aims to compare in-hospital all-cause mortality and kidney recovery between patients with AKI who received acute PD versus extracorporeal dialysis (intermittent haemodialysis and continuous kidney replacement therapy). METHODS In a retrospective observational study of 259 patients with AKI requiring dialysis during the COVID-19 surge during Spring 2020 in New York City, we compared 30-day all-cause mortality and kidney recovery between 93 patients who received acute PD at any time point and 166 patients who only received extracorporeal dialysis. Kaplan-Meier curves, log-rank test and Cox regression were used to compare survival and logistic regression was used to compare kidney recovery. RESULTS The mean age was 61 ± 11 years; 31% were women; 96% had confirmed COVID-19 with median follow-up of 21 days. After adjusting for demographics, comorbidities, oxygenation and laboratory values prior to starting dialysis, the use of PD was associated with a lower mortality rate compared to extracorporeal dialysis with a hazard ratio of 0.48 (95% confidence interval: 0.27-0.82, p = 0.008). At discharge or on day 30 of hospitalisation, there was no association between dialysis modality and kidney recovery (p = 0.48). CONCLUSIONS The use of PD for the treatment of AKI was not associated with worse clinical outcomes when compared to extracorporeal dialysis during the height of the COVID-19 pandemic in New York City. Given the inherent selection biases and residual confounding in our observational study, research with a larger cohort of patients in a more controlled setting is needed to confirm our findings.
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Affiliation(s)
- Maryanne Y Sourial
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Anirudh Gone
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Jaime Uribarri
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vesh Srivatana
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
- The Rogosin Institute, New York, NY, USA
| | - Shuchita Sharma
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniil Shimonov
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
- The Rogosin Institute, New York, NY, USA
| | - Michael Chang
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Wenzhu Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rochelle Dalsan
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kaltrina Sedaliu
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Swati Jain
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Michael J Ross
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Nina Caplin
- Division of Nephrology, New York University Langone Health and New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York City Health and Hospitals/Bellevue, New York, NY, USA
| | - Wei Chen
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
- Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Wald R, Beaubien-Souligny W, Chanchlani R, Clark EG, Neyra JA, Ostermann M, Silver SA, Vaara S, Zarbock A, Bagshaw SM. Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Intensive Care Med 2022; 48:1368-1381. [PMID: 36066597 DOI: 10.1007/s00134-022-06851-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Critical illness is often complicated by acute kidney injury (AKI). In patients with severe AKI, renal replacement therapy (RRT) is deployed to address metabolic dysfunction and volume excess until kidney function recovers. This review is intended to provide a comprehensive update on key aspects of RRT prescription and delivery to critically ill patients. Recently completed trials have enhanced the evidence base regarding several RRT practices, most notably the timing of RRT initiation and anticoagulation for continuous therapies. Better evidence is still needed to clarify several aspects of care including optimal targets for ultrafiltration and effective strategies for RRT weaning and discontinuation.
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Affiliation(s)
- Ron Wald
- Division of Nephrology, St. Michael's Hospital and the University of Toronto, 61 Queen Street East, 9-140, Toronto, ON, M5C 2T2, Canada. .,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | | | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Javier A Neyra
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marlies Ostermann
- Department of Critical Care Medicine, Guys and St. Thomas Hospital, London, UK
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Suvi Vaara
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, Muenster, Germany
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
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Diniz LRL, Elshabrawy HA, Souza MTDS, Duarte ABS, Datta S, de Sousa DP. Catechins: Therapeutic Perspectives in COVID-19-Associated Acute Kidney Injury. Molecules 2021; 26:5951. [PMID: 34641495 PMCID: PMC8512361 DOI: 10.3390/molecules26195951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022] Open
Abstract
Data obtained from several intensive care units around the world have provided substantial evidence of the strong association between impairment of the renal function and in-hospital deaths of critically ill COVID-19 patients, especially those with comorbidities and requiring renal replacement therapy (RRT). Acute kidney injury (AKI) is a common renal disorder of various etiologies characterized by a sudden and sustained decrease of renal function. Studies have shown that 5-46% of COVID-19 patients develop AKI during hospital stay, and the mortality of those patients may reach up to 100% depending on various factors, such as organ failures and RRT requirement. Catechins are natural products that have multiple pharmacological activities, including anti-coronavirus and reno-protective activities against kidney injury induced by nephrotoxic agents, obstructive nephropathies and AKI accompanying metabolic and cardiovascular disorders. Therefore, in this review, we discuss the anti-SARS-CoV-2 and reno-protective effects of catechins from a mechanistic perspective. We believe that catechins may serve as promising therapeutics in COVID-19-associated AKI due to their well-recognized anti-SARS-CoV-2, and antioxidant and anti-inflammatory properties that mediate their reno-protective activities.
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Affiliation(s)
| | - Hatem A. Elshabrawy
- Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA;
| | | | | | - Sabarno Datta
- College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA;
| | - Damião Pergentino de Sousa
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-970, PB, Brazil;
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Duan Z, Cai G, Li J, Chen F, Chen X. Meta-Analysis of Renal Replacement Therapy for Burn Patients: Incidence Rate, Mortality, and Renal Outcome. Front Med (Lausanne) 2021; 8:708533. [PMID: 34434946 PMCID: PMC8381047 DOI: 10.3389/fmed.2021.708533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Renal replacement therapy (RRT) was often needed by some severe burn patients with acute kidney injury (AKI). The primary aim of this study was to review incidence rate and mortality of RRT in severe burn patients. Second aims were to review RRT complications and renal outcome. Methods: We searched multiple databases for studies published between 1 January 1960 and 31 December 2019. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 57 studies, including 27,437 patients were enrolled in our analysis. The prevalence rates of RRT were 8.34% (95% CI 7.18–9.5%) in all burn patients and 37.05% (95% CI 29.85–44.24%) in AKI patients. The mortality of all burn patients with RRT was 65.52% (95% CI 58.41–72.64%). The prevalence rates of RRT in sample size≥100 group were 6.86% (95% CI 5.70–8.03%), which was lower than that of <100 group (17.61%, 95% CI 13.39–21.82%). With the increase of TBSA, the prevalence of RRT may have the increasing trend. The prevalence rates of RRT in Asian group was 12.75% (95% CI 9.50–16.00%), which was higher than that of European (10.45%, 95% CI 7.30–13.61%) and North America group (5.61%, 95% CI 4.27–6.95%). The prevalence rates of RRT in 2010–2019 group was 12.22% (95% CI 10.09–14.35%), which was higher than that of 2009–2000 group (5.17%, 95% CI 2.88–7.46%). The prevalence rates of RRT in 1989 and before group was the lowest, which was 1.56% (95% CI 0–3.68%). However, there was no significant correlation between the year of publication and the mortality of burn patients with RRT. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain haemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence rate of RRT is about 6–8%; approximately, one-third of burn patients with AKI need RRT. The prevalence rate of RRT increased over time, but the mortality did not change. The prevalence rates of RRT in Asian group was higher than that of European and North America group.
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Affiliation(s)
- ZhiYu Duan
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Nephrology, The Fourth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - GuangYan Cai
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - JiJun Li
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Nephrology, The Fourth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - FengKun Chen
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Nephrology, The Fourth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - XiangMei Chen
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China
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