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Hadley S, Thompson J, Beltramo F, Marcum J, Reuter-Rice K. Impact of Continuous Renal Replacement Therapy Initiation Time, Kidney Injury, and Hypervolemia in Critically Ill Children. Crit Care Nurse 2024; 44:28-35. [PMID: 38821525 DOI: 10.4037/ccn2024440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND The mortality rate of pediatric patients who require continuous renal replacement therapy is approximately 42%, and outcomes vary considerably depending on underlying disease, illness severity, and time of dialysis initiation. Delay in the initiation of such therapy may increase mortality risk, prolong intensive care unit stay, and worsen clinical outcomes. LOCAL PROBLEM In the pediatric intensive care unit of an urban level I trauma children's hospital, continuous renal replacement therapy initiation times and factors associated with delays in therapy were unknown. METHODS This quality improvement process involved a retrospective review of data on patients who received continuous dialysis in the pediatric intensive care unit from January 1, 2017, to December 31, 2021. The objectives were to examine the characteristics of the children requiring continuous renal replacement therapy, therapy initiation times, and factors associated with initiation delays that might affect unit length of stay and mortality. RESULTS During the study period, 175 patients received continuous renal replacement therapy, with an average initiation time of 11.9 hours. Statistically significant associations were found between the degree of fluid overload and mortality (P < .001) and between the presence of acute kidney injury and prolonged length of stay (P = .04). No significant association was found between therapy initiation time and unit length of stay or mortality, although the average initiation time of survivors was 5.9 hours shorter than that of nonsurvivors. CONCLUSION Future studies are needed to assess real time delays and to evaluate if the implementation of a standardized initiation process decreases initiation time.
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Affiliation(s)
- Sierra Hadley
- Sierra Hadley is an acute care pediatric nurse practitioner in the pediatric intensive care unit at Children's Hospital Los Angeles, California
| | - Julie Thompson
- Julie Thompson is a consulting associate at the Duke University School of Nursing, Durham, North Carolina
| | - Fernando Beltramo
- Fernando Beltramo is an attending physician, an intensivist, and Director of the pediatric intensive care unit at Children's Hospital Los Angeles and an assistant professor of clinical pediatrics at the Keck School of Medicine of USC, Los Angeles, California
| | - John Marcum
- John Marcum is an attending physician and an intensivist at Children's Hospital Los Angeles and an assistant professor of clinical pediatrics at the Keck School of Medicine of USC
| | - Karin Reuter-Rice
- Karin Reuter-Rice is an associate professor at the Duke University School of Nursing, School of Medicine, and the Duke Institute for Brain Sciences. She is also faculty in the Division of Pediatric Critical Care, Duke University Health System
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2
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Landa-Moreno CI, Trejo-Hurtado CM, Lemus-de la Cruz J, Peña-Montes DJ, Murillo-Villicaña M, Huerta-Cervantes M, Montoya-Pérez R, Salgado-Garciglia R, Manzo-Avalos S, Cortés-Rojo C, Monribot-Villanueva JL, Guerrero-Analco JA, Saavedra-Molina A. Antioxidant Effect of the Ethyl Acetate Extract of Potentilla indica on Kidney Mitochondria of Streptozotocin-Induced Diabetic Rats. PLANTS (BASEL, SWITZERLAND) 2023; 12:3196. [PMID: 37765360 PMCID: PMC10538127 DOI: 10.3390/plants12183196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia. This state may lead to an increase in oxidative stress, which contributes to the development of diabetes complications, including diabetic kidney disease. Potentilla indica is a traditional medicinal herb in Asia, employed in the treatment of several diseases, including DM. In this study, we investigated the antioxidant effect of the ethyl acetate extract of Potentilla indica both in vitro and on kidneys of streptozotocin-induced diabetic male rats. Firstly, phytochemicals were identified via UPLC-MS/MS, and their in vitro antioxidant capabilities were evaluated. Subsequently, male Wistar rats were assigned into four groups: normoglycemic control, diabetic control, normoglycemic treated with the extract, and diabetic treated with the extract. At the end of the treatment, fasting blood glucose (FBG) levels, creatinine, blood urea nitrogen (BUN), and uric acid were estimated. Furthermore, the kidneys were removed and utilized for the determination of mitochondrial reactive oxygen species (ROS) production, mitochondrial respiratory chain complex activities, mitochondrial lipid peroxidation, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT) activities. The in vitro findings showed that the major phytochemicals present in the extract were phenolic compounds, which exhibited a potent antioxidant activity. Moreover, the administration of the P. indica extract reduced creatinine and BUN levels, ROS production, and lipid peroxidation and improved mitochondrial respiratory chain complex activity and GSH-Px, SODk, and CAT activities when compared to the diabetic control group. In conclusion, our data suggest that the ethyl acetate extract of Potentilla indica possesses renoprotective effects by reducing oxidative stress on the kidneys of streptozotocin-induced diabetic male rats.
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Affiliation(s)
- Cinthia I. Landa-Moreno
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Cristian M. Trejo-Hurtado
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Jenaro Lemus-de la Cruz
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Donovan J. Peña-Montes
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Marina Murillo-Villicaña
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Maribel Huerta-Cervantes
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Rocío Montoya-Pérez
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Rafael Salgado-Garciglia
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Salvador Manzo-Avalos
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Christian Cortés-Rojo
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
| | - Juan Luis Monribot-Villanueva
- Red de Estudios Moleculares Avanzados, Clúster BioMimic, Instituto de Ecología, A.C., Xalapa 91073, Veracruz, Mexico; (J.L.M.-V.); (J.A.G.-A.)
| | - José Antonio Guerrero-Analco
- Red de Estudios Moleculares Avanzados, Clúster BioMimic, Instituto de Ecología, A.C., Xalapa 91073, Veracruz, Mexico; (J.L.M.-V.); (J.A.G.-A.)
| | - Alfredo Saavedra-Molina
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Francisco J. Múgica S/N, Morelia 58030, Michoacán, Mexico; (C.I.L.-M.); (C.M.T.-H.); (J.L.-d.l.C.); (D.J.P.-M.); (M.M.-V.); (M.H.-C.); (R.M.-P.); (R.S.-G.); (S.M.-A.); (C.C.-R.)
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3
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Zhang X, Yuan Y. Effect of replacement therapy (CRRT) and hemodialysis (IHD) on severe acute renal failure. Front Pharmacol 2023; 14:1122778. [PMID: 37547338 PMCID: PMC10400762 DOI: 10.3389/fphar.2023.1122778] [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: 12/13/2022] [Accepted: 07/12/2023] [Indexed: 08/08/2023] Open
Abstract
Hyperkalemia, metabolic acidosis, and acute uremia are the main symptoms in patients with severe acute renal failure (SARF). Its clinical symptoms are obvious, and it is extremely harmful. It needs to take active and effective measures for treatment. CRRT refers to any extracorporeal blood purification treatment technique designed to replace impaired renal function for 24 h or nearly 24 h. Hemodialysis treatment is a treatment process in which the patient's blood is discharged from the body, passes through the dialysis membrane and dialysis machine, removes excess toxins and water in the body, corrects electrolyte and acid-base disorders, and then returns the blood to the body. In order to explore the efficacy of replacement therapy and hemodialysis in the treatment of severe acute renal failure, the data samples were randomly divided into observation group and control group, who were given conventional treatment, hemodialysis and replacement therapy, respectively. Clinical data show that after replacement therapy and hemodialysis in patients with severe acute renal failure in the observation group, the levels of parathyroid hormone, renin, and quality of life were all improved, with an improvement rate of 9.47%, which has certain promotional value.
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Affiliation(s)
- Xiangyuan Zhang
- Critical Care Medicine, Shaoyang University Affiliated Second Hospital, Shaoyang, China
| | - Yinfang Yuan
- Nephrology Department, Shaoyang University Affiliated Second Hospital, Shaoyang, China
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4
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Severe Malaria in an Adult Patient from Low-Endemic Area in Flores Island, East Nusa Tenggara. Case Rep Med 2023; 2023:1239318. [PMID: 36865611 PMCID: PMC9974305 DOI: 10.1155/2023/1239318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
Malaria is an infection caused by protozoa of the genus Plasmodium, commonly found in tropical and subtropical regions worldwide. Plasmodium falciparum causes the most severe form of the disease and may progress to life-threatening manifestations. This case describes a 26-year-old man who suffered cerebral malaria with multiple organ dysfunction and successfully recovered despite poor initial prognosis. Negligent and late diagnosis of malaria leads to severe complications and a worse prognosis. This case emphasizes despite living in a low-endemic malaria area, physicians should remain meticulous and consider malaria as differential diagnosis even after initially presenting with nonspecific symptoms. Consequently, malarial screening should be performed to modify the risk of mortality. Furthermore, close monitoring and early administration of intravenous artesunate are also particularly critical.
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5
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Fayad AI, Buamscha DG, Ciapponi A. Timing of kidney replacement therapy initiation for acute kidney injury. Cochrane Database Syst Rev 2022; 11:CD010612. [PMID: 36416787 PMCID: PMC9683115 DOI: 10.1002/14651858.cd010612.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICUs) and is associated with high numbers of deaths. Kidney replacement therapy (KRT) is a blood purification technique used to treat the most severe forms of AKI. The optimal time to initiate KRT so as to improve clinical outcomes remains uncertain. This is an update of a review first published in 2018. This review complements another Cochrane review by the same authors: Intensity of continuous renal replacement therapy for acute kidney injury. OBJECTIVES To assess the effects of different timing (early and standard) of KRT initiation on death and recovery of kidney function in critically ill patients with AKI. SEARCH METHODS We searched the Cochrane Kidney and Transplant's Specialised Register to 4 August 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register, ClinicalTrials and LILACS to 1 August 2022. SELECTION CRITERIA We included all randomised controlled trials (RCTs). We included all patients with AKI in the ICU regardless of age, comparing early versus standard KRT initiation. For safety and cost outcomes, we planned to include cohort studies and non-RCTs. DATA COLLECTION AND ANALYSIS Data were extracted independently by two authors. The random-effects model was used, and results were reported as risk ratios(RR) for dichotomous outcomes and mean difference(MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS We included 12 studies enrolling 4880 participants. Overall, most domains were assessed as being at low or unclear risk of bias. Compared to standard treatment, early KRT initiation may have little to no difference on the risk of death at day 30 (12 studies, 4826 participants: RR 0.97,95% CI 0.87 to 1.09; I²= 29%; low certainty evidence), and death after 30 days (7 studies, 4534 participants: RR 0.99, 95% CI 0.92 to 1.07; I² = 6%; moderate certainty evidence). Early KRT initiation may make little or no difference to the risk of death or non-recovery of kidney function at 90 days (6 studies, 4011 participants: RR 0.91, 95% CI 0.74 to 1.11; I² = 66%; low certainty evidence); CIs included both benefits and harms. Low certainty evidence showed early KRT initiation may make little or no difference to the number of patients who were free from KRT (10 studies, 4717 participants: RR 1.07, 95% CI 0.94 to1.22; I² = 55%) and recovery of kidney function among survivors who were free from KRT after day 30 (10 studies, 2510 participants: RR 1.02, 95% CI 0.97 to 1.07; I² = 69%) compared to standard treatment. High certainty evidence showed early KRT initiation increased the risk of hypophosphataemia (1 study, 2927 participants: RR 1.80, 95% CI 1.33 to 2.44), hypotension (5 studies, 3864 participants: RR 1.54, 95% CI 1.29 to 1.85; I² = 0%), cardiac-rhythm disorder (6 studies, 4483 participants: RR 1.35, 95% CI 1.04 to 1.75; I² = 16%), and infection (5 studies, 4252 participants: RR 1.33, 95% CI 1.00 to 1.77; I² = 0%); however, it is uncertain whether early KRT initiation increases or reduces the number of patients who experienced any adverse events (5 studies, 3983 participants: RR 1.23, 95% CI 0.90 to 1.68; I² = 91%; very low certainty evidence). Moderate certainty evidence showed early KRT initiation probably reduces the number of days in hospital (7 studies, 4589 participants: MD-2.45 days, 95% CI -4.75 to -0.14; I² = 10%) and length of stay in ICU (5 studies, 4240 participants: MD -1.01 days, 95% CI -1.60 to -0.42; I² = 0%). AUTHORS' CONCLUSIONS Based on mainly low to moderate certainty of the evidence, early KRT has no beneficial effect on death and may increase the recovery of kidney function. Earlier KRT probably reduces the length of ICU and hospital stay but increases the risk of adverse events. Further adequate-powered RCTs using robust and validated tools that complement clinical judgement are needed to define the optimal time of KRT in critical patients with AKI in order to improve their outcomes. The surgical AKI population should be considered in future research.
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Affiliation(s)
- Alicia Isabel Fayad
- Pediatric Nephrology, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Daniel G Buamscha
- Pediatric Critical Care Unit, Juan Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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Xiao C, Xiao J, Cheng Y, Li Q, Li W, He T, Li S, Gao D, Shen F. The Efficacy and Safety of Early Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:820624. [PMID: 35265638 PMCID: PMC8898954 DOI: 10.3389/fmed.2022.820624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
The efficacy and safety of early renal replacement therapy (eRRT) for critically ill patients with acute kidney injury (AKI) remain controversial. Therefore, the purpose of our study was to perform an up-to-date meta-analysis with the trial sequential analysis (TSA) of randomized controlled trials (RCTs) to evaluate the therapeutic effect of eRRT on patients in an intensive care unit (ICU). We extensively searched MEDLINE, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov, Gray Literature Report, and Bielefeld Academic Search Engine (BASE), and conducted an updated search on December 27, 2021. The included studies were RCTs, which compared the efficacy and safety of eRRT and delayed renal replacement therapy (dRRT) on critically ill patients with AKI. We adopted TSA and sensitivity analysis to strengthen the robustness of the results. About 12 RCTs with a total of 5,423 participants were included. Patients receiving eRRT and dRRT had the similar rate of all-cause mortality at day 28 (38.7% vs. 38.9%) [risk ratio (RR), 1.00; 95%CI, 0.93-1.07, p = 0.93, I 2 = 0%, p = 0.93]. A sensitivity and subgroup analysis produced similar results for the primary outcome. TSA showed that the required information size was 5,034, and the cumulative Z-curve crossed trial sequential monitoring boundaries for futility. Patients receiving eRRT had a higher rate of renal replacement therapy (RRT) (RR, 1.50, 95% CI: 1.28-1.76, p < 0.00001, I 2 = 96%), and experienced more adverse events comparing to those receiving dRRT (RR: 1.41, 95% CI: 1.22-1.63, p < 0.0001, heterogeneity not applied). The most remarkable and important experimental finding is that, to our knowledge, the current meta-analysis included the largest sample size from the RCTs, which were published in the past 10 years to date, show that eRRT had no significant survival benefit for ill patients with AKI compared with dRRT and TSA indicating that no more studies were needed to confirm it. Trial Registration INPLASY, INPLASY2020120030. Registered 04 December 2020.
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Affiliation(s)
- Chuan Xiao
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Jingjing Xiao
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Yumei Cheng
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Qing Li
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Wei Li
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Tianhui He
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Shuwen Li
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Daixiu Gao
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Feng Shen
- Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,School of Clinical Medicine, Guizhou Medical University, Guiyang, China
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Does delivering more dialysis improve clinical outcomes? What randomized controlled trials have shown. J Nephrol 2022; 35:1315-1327. [PMID: 35041196 DOI: 10.1007/s40620-022-01246-8] [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: 11/03/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
Some randomized controlled trials (RCTs) have sought to determine whether different dialysis techniques, dialysis doses and frequencies of treatment are able to improve clinical outcomes in end-stage kidney disease (ESKD). Virtually all of these RCTs were enacted on the premise that 'more' haemodialysis might improve clinical outcomes compared to 'conventional' haemodialysis. Aim of the present narrative review was to analyse these landmark RCTs by posing the following question: were their intervention strategies (i.e., earlier dialysis start, higher haemodialysis dose, intensive haemodialysis, increase in convective transport, starting haemodialysis with three sessions per week) able to improve clinical outcomes? The answer is no. There are at least two main reasons why many RCTs have failed to demonstrate the expected benefits thus far: (1) in general, RCTs included relatively small cohorts and short follow-ups, thus producing low event rates and limited statistical power; (2) the designs of these studies did not take into account that ESKD does not result from a single disease entity: it is a collection of different diseases and subtypes of kidney dysfunction. Patients with advanced kidney failure requiring dialysis treatment differ on a multitude of levels including residual kidney function, biochemical parameters (e.g., acid base balance, serum electrolytes, mineral and bone disorder), and volume overload. In conclusion, the different intervention strategies of the RCTs herein reviewed were not able to improve clinical outcomes of ESKD patients. Higher quality studies are needed to guide patients and clinicians in the decision-making process. Future RCTs should account for the heterogeneity of patients when considering inclusion/exclusion criteria and study design, and should a priori consider subgroup analyses to highlight specific subgroups that can benefit most from a particular intervention.
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8
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An JN, Kim SG, Song YR. When and why to start continuous renal replacement therapy in critically ill patients with acute kidney injury. Kidney Res Clin Pract 2021; 40:566-577. [PMID: 34781642 PMCID: PMC8685358 DOI: 10.23876/j.krcp.21.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/22/2021] [Indexed: 01/20/2023] Open
Abstract
Acute kidney injury (AKI) is a common condition in critically ill patients, and may contribute to significant medical, social, and economic consequences, including death. Although there have been advances in medical technology, including continuous renal replacement therapy (CRRT), the mortality rate of AKI is high, and there is no fundamental treatment that can reverse disease progression. The decision to implement CRRT is often subjective and based primarily on the clinician’s judgment without consistent and concrete guidelines or protocols regarding when to initiate and discontinue CRRT and how to manage complications. Recently, several randomized controlled trials addressing the initiation of renal replacement therapy in critically ill patients with AKI have been completed, but clinical application of the findings is limited by the heterogeneity of the objectives and research designs. In this review, the advantages and disadvantages of CRRT initiation, clinical guideline recommendations, and the results of currently published clinical trials and meta-analyses are summarized to guide patient care and identify future research priorities.
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Affiliation(s)
- Jung Nam An
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Sung Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Young Rim Song
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Hallym University Kidney Research Institute, Anyang, Republic of Korea.,Department of Biomedical Gerontology, Graduate School of Hallym University, Chuncheon, Korea
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9
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Jonny J, Violetta L. Acute Kidney Injury and Jaundice in a Patient With Concurrent Severe Malaria and Acute Exacerbation of Hepatitis B. J Investig Med High Impact Case Rep 2021; 9:23247096211043712. [PMID: 34477014 PMCID: PMC8422820 DOI: 10.1177/23247096211043712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients chronically infected with hepatitis B virus (HBV) may travel to areas with high endemicity of malaria. The overlap between malaria and HBV infection can be clinically severe and present a diagnostic challenge as both diseases manifest similar symptoms. This case describes a fatal case of a 43-year-old man with chronic HBV infected with Plasmodium falciparum malaria that presents as acute kidney injury (AKI) and jaundice following a trip to malaria-endemic region. Despite administering antimalarial and 6 courses of renal replacement therapy, the patient’s clinical condition did not improve, leading to septic shock, multi-organ dysfunction, and eventually, death. AKI and jaundice are commonly seen in severe P. falciparum malaria, as well as acute exacerbation of chronic HBV. This case emphasizes the importance to consider malarial screening when evaluating sick returning travelers, even in those with underlying chronic HBV. Given the severity of coinfection, prompt identification of this overlap can avert the rapid deterioration of severe malaria by early administration of intravenous artesunate and renal replacement therapy.
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Affiliation(s)
- Jonny Jonny
- Gatot Soebroto Army Central Hospital, Jakarta, Indonesia
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10
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D’souza PS, Holla R, Swamy G. Effect of Adhatoda zeylanica Ethanolic Extract on Attenuated Kidney in Streptozotocin-Induced Diabetic Rats. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0040-1722801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Objective The present study was aimed to evaluate the effect of ethanolic extract of Adhatoda zeylanica (EAZ) leaves on streptozotocin (STZ)-induced diabetes mellitus (DM) and its renal complications in male Wistar albino rats.
Materials and Methods Adult male Wistar albino rats were randomly selected from a colony, divided into four groups, namely, A, B, C, and D, with each having six rats (n = 6) and each weighing between 200 and 250 g. Group A served as control and received only water per oral (p.o.). Group B, C, and D animals received a single dose of STZ at 45 mg/kg body weight (kbw) intraperitoneal administration (i.p.) on day 1 and observed for fasting blood glucose (FBG) to induce DM for next 72 hours. After the DM was induced, group B served as DM control, group C received the standard drug glibenclamide (GL) at 5 mg/kbw p.o. once daily, and group D received EAZ of 500 mg/kbw p.o. once daily for 35 days. After the observation period, the animals were euthanized, serum creatinine and blood urea, antioxidants in the kidney tissue homogenate, and histopathological studies were assessed to know the ameliorative effect of the test drugs.
Results Renal parameters, such as serum creatinine, blood urea, antioxidants activities, in group D were nearer to the control when compared with groups B and C. Histopathological studies revealed that there was minimal renal damage in group D when compared with groups B and C.
Conclusion Administration of ethanolic EAZ showed significant ameliorative effects on the FBG, biochemical, oxidative, and histopathological parameters on kidney tissues treated with STZ to induce DM.
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Affiliation(s)
| | - Rajendra Holla
- Department of Pharmacology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
| | - Gangadhara Swamy
- Department of Anatomy, Subbiah Institute of Medical Sciences and Research Center, Shivamogga, Karnataka, India
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11
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Darden DB, Moore FA, Brakenridge SC, Navarro EB, Anton SD, Leeuwenburgh C, Moldawer LL, Mohr AM, Efron PA, Mankowski RT. The Effect of Aging Physiology on Critical Care. Crit Care Clin 2021; 37:135-150. [PMID: 33190766 PMCID: PMC8194285 DOI: 10.1016/j.ccc.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Older patients experience a decline in their physiologic reserves as well as chronic low-grade inflammation named "inflammaging." Both of these contribute significantly to aging-related factors that alter the acute, subacute, and chronic response of these patients to critical illness, such as sepsis. Unfortunately, this altered response to stressors can lead to chronic critical illness followed by dismal outcomes and death. The primary goal of this review is to briefly highlight age-specific changes in physiologic systems majorly affected in critical illness, especially because it pertains to sepsis and trauma, which can lead to chronic critical illness and describe implications in clinical management.
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Affiliation(s)
- Dijoia B Darden
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Frederick A Moore
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Scott C Brakenridge
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Eduardo B Navarro
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA
| | - Lyle L Moldawer
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Robert T Mankowski
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA.
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12
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McGalliard RJ, McWilliam SJ, Maguire S, Jones CA, Jennings RJ, Siner S, Newland P, Peak M, Chesters C, Jeffers G, Broughton C, McColl L, Lane S, Paulus S, Cunliffe NA, Baines P, Carrol ED. Identifying critically ill children at high risk of acute kidney injury and renal replacement therapy. PLoS One 2020; 15:e0240360. [PMID: 33119655 PMCID: PMC7595286 DOI: 10.1371/journal.pone.0240360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI), a common complication in paediatric intensive care units (PICU), is associated with increased morbidity and mortality. In this single centre, prospective, observational cohort study, neutrophil gelatinase-associated lipocalin in urine (uNGAL) and plasma (pNGAL) and renal angina index (RAI), and combinations of these markers, were assessed for their ability to predict severe (stage 2 or 3) AKI in children and young people admitted to PICU. In PICU children and young people had initial and serial uNGAL and pNGAL measurements, RAI calculation on day 1, and collection of clinical data, including serum creatinine measurements. Primary outcomes were severe AKI and renal replacement therapy (RRT). Secondary outcomes were length of stay, hospital acquired infection and mortality. The area under the Receiver Operating Characteristic (ROC) curves and Youden index was used to determine biomarker performance and identify optimum cut-off values. Of 657 children recruited, 104 met criteria for severe AKI (15∙8%) and 47 (7∙2%) required RRT. Severe AKI was associated with increased length of stay, hospital acquired infection, and mortality. The area under the curve (AUC) for severe AKI prediction for Day 1 uNGAL, Day 1 pNGAL and RAI were 0.75 (95% Confidence Interval [CI] 0∙69, 0∙81), 0∙64 (95% CI 0∙56, 0∙72), and 0.73 (95% CI 0∙65, 0∙80) respectively. The optimal combination of measures was RAI and day 1 uNGAL, giving an AUC of 0∙80 for severe AKI prediction (95% CI 0∙71, 0∙88). In this heterogenous PICU cohort, urine or plasma NGAL in isolation had poorer prediction accuracy for severe AKI than in previously reported homogeneous populations. However, when combined together with RAI, they produced good prediction for severe AKI.
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Affiliation(s)
- Rachel J. McGalliard
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen J. McWilliam
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Department of Women’s and Children’s Health, Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- MRC Centre for Drug Safety Science, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, First Floor Liverpool Science Park, Liverpool, United Kingdom
- * E-mail:
| | - Samuel Maguire
- Medical School, University of Liverpool, Liverpool, United Kingdom
| | - Caroline A. Jones
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Sarah Siner
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Paul Newland
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthew Peak
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Graham Jeffers
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Caroline Broughton
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Steven Lane
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephane Paulus
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nigel A. Cunliffe
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, First Floor Liverpool Science Park, Liverpool, United Kingdom
| | - Paul Baines
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Enitan D. Carrol
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, First Floor Liverpool Science Park, Liverpool, United Kingdom
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13
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Kotepui M, Kotepui KU, Milanez GDJ, Masangkay FR. Prevalence and risk factors related to poor outcome of patients with severe Plasmodium vivax infection: a systematic review, meta-analysis, and analysis of case reports. BMC Infect Dis 2020; 20:363. [PMID: 32448216 PMCID: PMC7245863 DOI: 10.1186/s12879-020-05046-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Plasmodium vivax rarely develops severe complications when compared to severe falciparum malaria. However, severe vivax malaria also needs urgent, intensive care and treatment as severe falciparum malaria. This systematic review aimed to explore pooled prevalence of severe vivax malaria and to identify factors related to poor outcome of patients who developed severe manifestation. Methods The systematic review conducted by two reviewers independently through searching of research publications related to severe P. vivax malaria in three databases including MEDLINE, Web of Science (ISI), and Scopus until October, 22 2019. The pooled prevalence of severe vivax malaria was achieved using STATA and RevMan 5 Software. Factors related to poor outcome of patients with severe vivax malaria were analyzed using SPSS 11.5 Software. Results Among 2615 research publications retrieved from three databases, 49 articles reporting on 42,325 severity cases were selected for calculating pooled prevalence. Seventy-six patients from case reports, case series, letter to editors, and research communications were collected to identify factors related to poor outcome of patients with severe vivax malaria. The results showed that severe anemia, jaundice, respiratory distress, impaired consciousness, and renal failure were the most common major manifestations of severe malaria guided by the World Health Organization (WHO) criterion. The meta-analysis indicated that severe malaria was less frequent in patient with P. vivax compared to those with P. falciparum (P -value < 0.00001, OR = 0.38, 95% CI = 0.25–0.56, I2 = 87%). In addition, thrombocytopenia, anemia, hepatitis, and severe thrombocytopenia were the most common minor complications. Analysis of cases indicated that convulsion, respiratory distress, renal failure, jaundice, anuria/oliguria, and complication during treatment impacted on longer hospital stays compared to other severe complications (P-value < 0.05). Respiratory distress was frequently found after first treatment with anti-malarial drugs (P-value = 0.002). Renal failure was frequently found before treatment with anti-malarial drugs (P-value = 0.016). Mean days of fever and higher pulse rates at presentation were predictors of poor outcome among patients with severe vivax malaria (P-value < 0.05). Conclusions Severe anemia was the most common major manifestation of P. vivax malaria guided by the WHO criterion. Severe anemia was found less frequently in patients with P. vivax than those with P. falciparum. Renal failure, jaundice, anuria/oliguria, and complication during treatment along with, mean days of fever and higher pulse rates at presentation might be predictors of poor outcome of patients with severe vivax malaria.
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Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
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14
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How and when do we use continuous renal replacement therapy for acute kidney injury in Serbia? - the multicentric survey. VOJNOSANIT PREGL 2020. [DOI: 10.2298/vsp191231110k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background / Aim. Absence of clear guidance in the definition, diagnostics
and indications for renal replacement treatment (RRT) is present. The aim of
this survey is creating a unique strategy for diagnostics and treatment of
acute kidney injury (AKI) based on the current clinical practice. Methods. ?
Results. We have conducted a multicentric web-survey among nephrologists
(46.8%) and other physicians in Serbia. The sample consisted of 119
participants, 78.9% out of which filled out the survey forms correctly, and
were, therefore, included in the analysis. Most of them responded that the
nephrologist indicates (76.8%) and prescribes (74.5%) of continuous renal
replacement therapy (CRRT).The application of KDIGO 2 criterion for ?early?
start of CRRT used 74.5% of the respondents, and 91.5% of them started
?late? initiation of CRRT in the presence of complications associated with
AKI or poor response to conservative treatment. Regarding clinical
experience of the respondents, 74.5% of them marked ?early? start of CRRT
within 12 hours whereas 56.4% of them considered the start of CRRT after 48h
as ?late?. The most commonly used modality was continuous venous
hemodiafiltration (37.6%). Most participants used heparin as anticoagulant
(95.7%) with average life span of filters less than 24 hours (71.3%) and 25
ml/kg/h efficiency target dialysis effluent dose (45.2%) during CRRT. The
most common complications of CRRT were hypotension (55.3%) and
catheter-related infections (29.8%). Conclusion. ?Early? start of CRRT is
considered favorite by the majority of the participants. According to the
obtained data, standardization of the strategy in the diagnostics and
treatment of AKI is necessary.
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15
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Optimal timing of initiating continuous renal replacement therapy in septic shock patients with acute kidney injury. Sci Rep 2019; 9:11981. [PMID: 31427640 PMCID: PMC6700095 DOI: 10.1038/s41598-019-48418-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
Acute kidney injury (AKI) in patients with septic shock is associated with high mortality, but the appropriate timing for initiating continuous renal replacement therapy (CRRT) is controversial. We retrospectively enrolled 158 septic shock patients with AKI in the medical intensive care unit (ICU) from July 2016 to April 2018. The time from AKI onset to CRRT initiation was compared according to ICU mortality using Cox proportional hazard, receiver operating characteristic, and Kaplan-Meier survival analyses. At the time of ICU discharge, the mortality rate was 50.6% (n = 80). It took longer to initiate CRRT in non-survivors than in survivors (hazard ratio 1.009; 95% confidence interval [CI] 1.003–1.014; P = 0.002). The cut-off time from AKI onset to CRRT initiation for ICU mortality was 16.5 hours (area under the curve 0.786; 95% CI 0.716–0.856; P < 0.001). The cumulative mortality rate was significantly higher in patients in whom CRRT was initiated beyond 16.5 hours after AKI onset than in those in whom CCRT was initiated within 16.5 hours (log-rank test, P < 0.001). Several clinical situations must be considered to determine the optimal timing of CRRT initiation in these patients. Close observation and CRRT initiation within 16.5 hours after AKI onset may help improve survival.
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16
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Srisawat N, Tangvoraphonkchai K, Lumlertgul N, Tungsanga K, Eiam-Ong S. Role of acute kidney injury biomarkers to guide renal replacement therapy initiation, what we learn from EARLY-RRT trial and FST trial? J Thorac Dis 2019; 10:E835-E838. [PMID: 30746270 DOI: 10.21037/jtd.2018.11.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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17
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Hoste EA, Vandenberghe W. Plasma neutrophil gelatinase-associated lipocalin (NGAL) for timing of initiation of renal replacement therapy for acute kidney injury? J Thorac Dis 2019; 10:S3989-S3993. [PMID: 30631536 DOI: 10.21037/jtd.2018.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric A Hoste
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Wim Vandenberghe
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
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18
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Fayad AII, Buamscha DG, Ciapponi A. Timing of renal replacement therapy initiation for acute kidney injury. Cochrane Database Syst Rev 2018; 12:CD010612. [PMID: 30560582 PMCID: PMC6517263 DOI: 10.1002/14651858.cd010612.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICUs), and is associated with high death. Renal replacement therapy (RRT) is a blood purification technique used to treat the most severe forms of AKI. The optimal time to initiate RRT so as to improve clinical outcomes remains uncertain.This review complements another Cochrane review by the same authors: Intensity of continuous renal replacement therapy for acute kidney injury. OBJECTIVES To assess the effects of different timing (early and standard) of RRT initiation on death and recovery of kidney function in critically ill patients with AKI. SEARCH METHODS We searched the Cochrane Kidney and Transplant's Specialised Register to 23 August 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. We also searched LILACS to 11 September 2017. SELECTION CRITERIA We included all randomised controlled trials (RCTs). We included all patients with AKI in ICU regardless of age, comparing early versus standard RRT initiation. For safety and cost outcomes we planned to include cohort studies and non-RCTs. DATA COLLECTION AND ANALYSIS Data were extracted independently by two authors. The random-effects model was used and results were reported as risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS We included five studies enrolling 1084 participants. Overall, most domains were assessed as being at low or unclear risk of bias. Compared to standard treatment, early initiation may reduce the risk of death at day 30, although the 95% CI does not rule out an increased risk (5 studies, 1084 participants: RR 0.83, 95% CI 0.61 to 1.13; I2 = 52%; low certainty evidence); and probably reduces the death after 30 days post randomisation (4 studies, 1056 participants: RR 0.92, 95% CI 0.76 to 1.10; I2= 29%; moderate certainty evidence); however in both results the CIs included a reduction and an increase of death. Earlier start may reduce the risk of death or non-recovery kidney function (5 studies, 1076 participants: RR 0.83, 95% CI 0.66 to 1.05; I2= 54%; low certainty evidence). Early strategy may increase the number of patients who were free of RRT after RRT discontinuation (5 studies, 1084 participants: RR 1.13, 95% CI 0.91 to 1.40; I2= 58%; low certainty evidence) and probably slightly increases the recovery of kidney function among survivors who discontinued RRT after day 30 (5 studies, 572 participants: RR 1.03, 95% CI 1.00 to 1.06; I2= 0%; moderate certainty evidence) compared to standard; however the lower limit of CI includes the null effect. Early RRT initiation increased the number of patients who experienced adverse events (4 studies, 899 participants: RR 1.10, 95% CI 1.03 to 1.16; I2 = 0%; high certainty evidence). Compared to standard, earlier RRT start may reduce the number of days in ICU (4 studies, 1056 participants: MD -1.78 days, 95% CI -3.70 to 0.13; I2 = 90%; low certainty evidence), but the CI included benefit and harm. AUTHORS' CONCLUSIONS Based mainly on low quality of evidence identified, early RRT may reduce the risk of death and may improve the recovery of kidney function in critically patients with AKI, however the 95% CI indicates that early RRT might worsen these outcomes. There was an increased risk of adverse events with early RRT. Further adequate-powered RCTs using appropriate criteria to define the optimal time of RRT are needed to reduce the imprecision of the results.
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Affiliation(s)
- Alicia Isabel I Fayad
- Ricardo Gutierrez Children's HospitalPediatric NephrologyInstitute for Clinical Effectiveness and Health PolicyLos Incas Av 4174Buenos AiresArgentina1427
| | - Daniel G Buamscha
- Juan Garrahan Children's HospitalPediatric Critical Care UnitCombate de Los Pozoz Y PichinchaBuenos AiresArgentina
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresArgentinaC1414CPV
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19
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Chen KH, Doi K, Wu VC, Chu TS, Shiao CC. Using 'temporal parameters' to define the timing of renal replacement therapy in acute kidney injury? There are other better choices. Nephrology (Carlton) 2018; 23:385-388. [PMID: 29696764 DOI: 10.1111/nep.13172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Kuan-Hua Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzong-Shinn Chu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, Luodong, Taiwan.,Saint Mary's Junior College of Medicine, Nursing and Management, Sanxing Township, Taiwan
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20
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Abstract
Acute kidney injury (AKI) is common in critically ill patients and associated with increased morbidity and mortality. With the increased use of renal replacement therapy (RRT) for severe AKI, the optimal time for initiation of RRT has become one of the most probed and debated topic in the field of nephrology and critical care. There appears to be an increased trend toward earlier initiation of RRT to avoid life-threatening complications associated with AKI. Despite the presence of a plethora of studies in this field, the lack of uniformity in study design, patient population types, definition of early and late initiation, modality of RRT, and results, the optimal time for starting RRT in AKI still remains unknown. The beneficial effects reported in observational studies have not been supported by clinical trials. Recently, 2 of the largest randomized control trials evaluating the timing of RRT in critically ill patients with AKI showed differing results. We provide an in-depth review of the available data on the timing of dialysis in patients with AKI.
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Affiliation(s)
- Nithin Karakala
- 1 Division of Nephrology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Ashita J Tolwani
- 3 Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Negi S, Koreeda D, Kobayashi S, Yano T, Tatsuta K, Mima T, Shigematsu T, Ohya M. Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies. Semin Dial 2018; 31:519-527. [PMID: 29738093 DOI: 10.1111/sdi.12705] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is one of the most common serious complications for all hospital admissions, with its incidence increasing among hospitalized patients, particularly those in the intensive care unit. Despite significant improvements in critical care and dialysis technology, AKI is associated with an increased risk of short- and long-term mortality, prolonged hospital stays, and dialysis dependence. These risks are particularly relevant for critically ill patients with AKI severe enough to require renal replacement therapy (RRT). No specific pharmacologic treatment has been established to treat AKI. Hence, the mainstay treatment for patients with AKI is RRT even though there are still several problematic issues regarding its use including RRT modality, dose, and timing. Recently, the impact of AKI on an increased risk of progression to chronic kidney disease (CKD) and end-stage renal disease requiring dialysis or transplantation is attracting increased attention.
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Affiliation(s)
- Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Koreeda
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Sou Kobayashi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Takuro Yano
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Tatsuta
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Toru Mima
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | | | - Masaki Ohya
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
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22
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Tian J, Niu L, An X. Cardiovascular risks in chronic kidney disease pediatric patients. Exp Ther Med 2017; 14:4615-4619. [PMID: 29201159 PMCID: PMC5704347 DOI: 10.3892/etm.2017.5117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022] Open
Abstract
One of the common factors for the premature death in children is advanced chronic kidney disease (CKD). Most often cardiovascular disease (CVD) is the reason for mortality. The cardiovascular (CV) morbidity starts early in the disease process and renal transplanted children (CKD-T) are also at risk. The present review is focused on the current views of the cardiovascular risks during CKD in pediatric patients. Variable data sources for the latest literature collection were explored which mainly included PubMed and Google Scholar. The most important risk factors for subclinical CVD were a young age, elevated BMI and systolic blood pressure z-scores as well as a low GFR and present albuminuria. Increasing blood pressure and BMI over follow-up were also important cardiac risk factors longitudinally. The present review concludes that altered cardiac function and remodeling are a concurrent part of the CKD process, start early in the disease development, and persist after renal transplantation. The findings suggest that children with CKD or CKD-T are at high risk for future CVD where younger patients with elevated BMI and slightly increased blood pressures, as well as present albuminuria, are those at greatest risk, thus indicating targets for future interventions.
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Affiliation(s)
- Jing Tian
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Ling Niu
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Xinjiang An
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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23
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Guerci P, Claudot JL, Novy E, Settembre N, Lalot JM, Losser MR. Immediate postoperative plasma neutrophil gelatinase-associated lipocalin to predict acute kidney injury after major open abdominal aortic surgery: A prospective observational study. Anaesth Crit Care Pain Med 2017; 37:327-334. [PMID: 29033359 DOI: 10.1016/j.accpm.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Plasma neutrophil gelatinase-associated lipocalin (pNGAL) has been used as a biomarker in acute kidney injury (AKI). AKI is a common postoperative complication of aortic surgery. We sought to evaluate the performance of the immediately postoperative pNGAL level in comparison with the serum creatinine (SCr) level in predicting AKI and the need for renal replacement therapy (RRT). PATIENTS AND METHODS Prospective non-interventional study in a university hospital. Fifty patients undergoing elective or emergent major intra-abdominal aortic surgery were included. Comparisons between groups of patients with or without postoperative AKI, according to KDIGO staging, were made. Performance of NGAL was determined by examining the area under receiver operating characteristic (AUROC) curve. RESULTS The incidence of AKI was 36%. At H+2, pNGAL values in AKI and non-AKI patients, respectively, were 221 [133-278] versus 50 [50-90] ng/mL (P<0.0001), and SCr values were 115 [96-178] versus 90 [72-99] μmol/L (P<0.0008). The AUROC of pNGAL for prediction of AKI was 0.90 (95% CI: 0.81-0.98) with an optimal cutoff of 112ng/mL, a sensitivity of 83%, specificity of 84%, and positive and negative predictive values of 75% and 90%, respectively. SCr produced an AUROC curve of 0.79 (0.65-0.92) at a cutoff of 110μmol/L. The diagnostic performance of pNGAL was significantly better than that of SCr (P=0.039). PNGAL at H+2 better predicted the RRT requirement [0.96 (0.90-1.0)] compared to SCr [0.86 (0.73-0.98)], but this difference was not statistically significant. CONCLUSIONS A 2-hour postoperative determination of pNGAL outperformed SCr level in predicting postoperative AKI after major aortic surgery.
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Affiliation(s)
- Philippe Guerci
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Jean-Louis Claudot
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Emmanuel Novy
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Nicla Settembre
- Department of Vascular Surgery, University Hospital of Nancy - Brabois, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Jean-Marc Lalot
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Marie-Reine Losser
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
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Silva GBD, Pinto JR, Barros EJG, Farias GMN, Daher EDF. Kidney involvement in malaria: an update. Rev Inst Med Trop Sao Paulo 2017; 59:e53. [PMID: 28793022 PMCID: PMC5626226 DOI: 10.1590/s1678-9946201759053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 11/30/2022] Open
Abstract
Malaria is an infectious disease of great importance for Public Health, as it is the
most prevalent endemic disease in the world, affecting millions of people living in
tropical areas of the globe. Kidney involvement is relatively frequent in infections
by P. falciparum and P. malariae, but has also been
described in the infection by P. vivax. Kidney complications in
malaria mainly occur due to hemodynamic dysfunction and immune response. Liver
complications leading to hepatomegaly, jaundice and hepatic dysfunction can also
contribute to the occurrence of acute kidney injury. Histologic studies in malaria
also evidence glomerulonephritis, acute tubular necrosis and acute interstitial
nephritis. It is also possible to find chronic kidney disease associated with
malaria, mainly in those patients suffering from repeated episodes of infection.
Plasmodium antigens have already been detected in the glomeruli, suggesting a direct
effect of the parasite in the kidney, which can trigger an inflammatory process
leading to different types of glomerulonephritis. Clinical manifestations of kidney
involvement in malaria include proteinuria, microalbuminuria and urinary casts,
reported in 20 to 50% of cases. Nephrotic syndrome has also been described in the
infection by P. falciparum, but it is rare. This paper highlights
the main aspects of kidney involvement in malaria and important findings of the most
recent research addressing this issue.
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Affiliation(s)
- Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | - José Reginaldo Pinto
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | - Elvino José Guardão Barros
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Rio Grande do Sul, Brazil
| | - Geysa Maria Nogueira Farias
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
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Zou H, Hong Q, Xu G. Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017. [PMID: 28623953 PMCID: PMC5474059 DOI: 10.1186/s13054-017-1707-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Acute kidney injury (AKI) is a common clinical complication of cardiac surgery and increases mortality and hospitalization. We aimed to explore and perform an updated meta-analysis of qualitative and quantitative evaluations of the relationship between early renal replacement therapy (RRT) and mortality. Methods We searched the Chinese Biomedical Database, the Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed. Results Fifteen studies (five randomized controlled trials (RCTs), one prospective cohort and nine retrospective cohorts) including 1479 patients were identified for detailed evaluation. The meta-analysis suggested that early RRT initiation reduced 28-day mortality (odds ratio (OR) 0.36; 95% confidence interval (CI) 0.23 to 0.57; I2 60%), and shortened intensive care unit (ICU) length of stay (LOS) (mean difference (MD) -2.50; 95% CI -3.53 to -1.47; I2 88%) and hospital LOS (MD -0.69; 95% CI -1.13 to -0.25; I2 88%), and also reduced the duration of RRT (MD -1.18; 95% CI -2.26 to -0.11; I2 69%), especially when RRT was initiated early within 12 hours (OR 0.23; 95% CI 0.08 to 0.63; I2 73%) and within 24 hours (OR 0.52; 95% CI 0.28 to 0.95; I2 58%) in patients with AKI after cardiac surgery. Conclusions Early RRT initiation decreased 28-day mortality, especially when it was started within 24 hours after cardiac surgery in patients with AKI.
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Affiliation(s)
- Honghong Zou
- Medical Center of the Graduate School, Nanchang University, Nanchang, People's Republic of China.,Department of Nephrology, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, People's Republic of China
| | - Qianwen Hong
- Science and Technology College, Jiangxi University of Traditional Chinese Medicine, Nanchang, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, People's Republic of China.
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Luo K, Fu S, Fang W, Xu G. The optimal time of initiation of renal replacement therapy in acute kidney injury: A meta-analysis. Oncotarget 2017; 8:68795-68808. [PMID: 28978157 PMCID: PMC5620297 DOI: 10.18632/oncotarget.17946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/30/2017] [Indexed: 01/11/2023] Open
Abstract
Background The impact on the timing of renal replacement therapy (RRT) initiation on clinical outcomes for patients with acute kidney injury (AKI) remains controversial. Materials and methods We searched the Cochrane Library, EMBASE, Global Health, MEDLINE, PubMed, the International Clinical Trials Registry Platform, and Web of Science. Results We included 49 studies involving 9698 patients. Pooled analysis of 5408 critically ill patients with AKI showed that early RRT was significantly associated with reduced mortality compared to late RRT [odds ratio (OR), 0.40; 95% confidential intervals (CI), 0.32 - 0.48; I2, 50.2%]. For 4290 non-critically ill patients with AKI, there was no statistically significant difference in the risk of mortality between early and late RRT (OR, 1.07; 95% CI, 0.79 - 1.45; I2, 73.0%). Early RRT was markedly associated with shortened intensive care units (ICU) length of stay (LOS) and hospital LOS compared to late RRT in both critically ill and non-critically ill patients with AKI. Conclusions Early RRT probably reduce the mortality, ICU and hospital LOS in critically ill patients with AKI. Inversely, early RRT in non-critically ill patients with AKI did not decrease the mortality, but shortened the ICU and hospital LOS.
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Affiliation(s)
- Kaiping Luo
- Medical Center of the Graduate School, Nanchang University, Nanchang, China
| | - Shufang Fu
- Medical Center of the Graduate School, Nanchang University, Nanchang, China
| | - Weidong Fang
- Department of Nephrology, People's Hospital of Ganzhou, Ganzhou, China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Bhatt GC, Das RR. Early versus late initiation of renal replacement therapy in patients with acute kidney injury-a systematic review & meta-analysis of randomized controlled trials. BMC Nephrol 2017; 18:78. [PMID: 28245793 PMCID: PMC5331682 DOI: 10.1186/s12882-017-0486-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in the critically ill patients and associated with a substantial morbidity and mortality. Severe AKI may be associated with up to 60% hospital mortality. Over the years, renal replacement therapy (RRT) has emerged as the mainstay of the treatment for AKI. However, the exact timing of initiation of RRT for better patient outcome is still debatable with conflicting data from randomized controlled trials. Thus, a systematic review and meta-analysis was performed to assess the impact of “early” versus “late” initiation of RRT. Methods All the published literature through the major databases including Medline/Pubmed, Embase, and Google Scholar were searched from 1970 to October 2016. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved papers concerning the effect of “early/prophylactic” RRT versus “late/as and when required” RRT were reviewed by the authors, and the data were extracted using a standardized data collection tool. Randomized trials (RCTs) comparing early initiation of RRT or prophylactic RRT with late or as and when required RRT were included. The primary outcome measures were all cause mortality and dialysis dependence on day 90. The secondary outcome measures were: length of ICU stay, length of hospital stay, recovery of renal function and adverse events. Results Of the 547 citation retrieved, full text of 44 articles was assessed for eligibility. Of these a total of 10 RCTs with 1,636 participants were included. All the trials were open label; six trials have unclear or high risk of bias for allocation concealment while four trials have low risk of bias for allocation concealment. There was a variable definition of early versus late in different studies. Thus, the definition of early or late was taken according to individual study definition. Compared to late RRT, there was no significant benefit of early RRT on day 30 mortality [6 studies; 1301 participants; RR, 0.92;95% CI: 0.76, 1.12); day 60 mortality [3 trials;1075 participants; RR, 0.94; 95% CI: 0.78, 1.14)]; day 90 mortality [3 trials; 555 participants; RR,0.94;95% CI: 0.67, 1.33)]; overall ICU or hospital mortality; dialysis dependence on day 90 [3 trials; (RR, 1.06; 95% CI:0.53, 2.12)]. There was no significant difference between length of ICU or hospital stay or recovery of renal functions. A subgroup analysis based on modality of RRT or mixed medical and surgical vs. surgical or based on severity of illness showed no difference in outcome measure. The trials with high or unclear risk of bias for allocation concealment showed benefit of early RRT (RR, 0.74; 95% CI: 0.59, 0.91) while the trials with low risk of bias for allocation concealment showed no difference in the mortality (RR, 1.02; 95% CI: 0.89, 1.17). Grade evidence generated for most of the outcomes was “low quality”. Conclusion This updated meta-analysis showed no added benefit of early initiation of RRT for patients with AKI. The grade evidence generated was of “low quality” and there was a high heterogeneity in the included trials. PROSPERO registration number CRD42016043092. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0486-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Room no.18, OPD Block, Bhopal, Madhya Pradesh, 462024, India.
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Meersch M, Schmidt C, Schmidt J, Zarbock A. Timing of renal replacement therapy in critically ill patients with acute kidney injury. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:360. [PMID: 27775733 DOI: 10.21037/atm.2016.09.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Melanie Meersch
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Christoph Schmidt
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Joachim Schmidt
- Department of Cardiac Surgery, University of Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
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