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Jakopin E, Knehtl M, Hojs NV, Bevc S, Piko N, Hojs R, Ekart R. Treatment of acute kidney injury with continuous renal replacement therapy and cytokine adsorber (CytoSorb®) in critically ill patients with COVID-19. Ther Apher Dial 2024. [PMID: 38958006 DOI: 10.1111/1744-9987.14182] [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: 10/16/2023] [Revised: 06/06/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION This retrospective study aimed to evaluate the 30 and 60-day survival of critically ill patients with COVID-19 and AKI. METHODS Inflammatory and biochemical biomarkers, length of intensive care unit (ICU) stay and mortality at Day 30 and Day 60 after ICU admission were analyzed. A total of 44 patients treated with continuous renal replacement therapy (CRRT) with cytokine adsorber (CA group) were compared to 58 patients treated with CRRT alone (non-CA group). RESULTS Patients in CA group were younger, had better preserved kidney function prior to the beginning of CRRT and had higher levels of interleukin-6. There were no statistically significant differences in their comorbidities and in other measured biomarkers between the two groups. The number of patients who died 60 days after ICU admission was statistically significantly higher in non-CA group (p = 0.029). CONCLUSION Treatment with CRRT and cytokine adsorber may have positively influenced 60-day survival in our COVID-19 ICU patients with AKI.
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Affiliation(s)
- Eva Jakopin
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Maša Knehtl
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Nina Vodošek Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Sebastjan Bevc
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
- Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Nejc Piko
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Radovan Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
- Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Robert Ekart
- Medical Faculty, University of Maribor, Maribor, Slovenia
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
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2
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Mohammadzadehmarandi A, Determan A, Krumm C, McIntosh LD, Zydney AL. High-performance countercurrent membrane purification for host cell protein removal from monoclonal antibody products. Biotechnol Bioeng 2023; 120:3585-3591. [PMID: 37593776 DOI: 10.1002/bit.28531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
The transition to continuous biomanufacturing has led to renewed interest in alternative approaches for downstream processing of monoclonal antibody (mAb) products. In this study, we examined the potential of using high-performance countercurrent membrane purification (HPCMP) for the removal of host cell proteins (HCPs) derived from Chinese Hamster Ovary cells in the purification of a mAb. Initial studies used several model proteins to identify appropriate operating conditions for the hollow fiber membrane modules. HPCMP was then used for mAb purification, with mAb yield >95% and more than 100-fold reduction in HCP. Stable operation was maintained for 48 h for feeds that were first prefiltered through the 3MTM Harvest RC chromatographic clarifier to remove DNA and other foulants. In addition, the Process Mass Intensity for HPCMP can be much less than that for alternative HCP separation processes. These results highlight the potential of using HPCMP as part of a fully continuous mAb production process.
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Affiliation(s)
- Aylin Mohammadzadehmarandi
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Amy Determan
- 3M Separation and Purification Sciences, St. Paul, Minnesota, USA
| | - Christian Krumm
- 3M Separation and Purification Sciences, St. Paul, Minnesota, USA
| | | | - Andrew L Zydney
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
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3
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Ibrahim UM, Jibo AM, Garba RM, Jalo RI, Tsiga-Ahmed FI, Musa A, Muazu S, Lisanework S, Buba LF, Sidi KS, Babatunde AL, Abdulsalam K, Karkarna MZ. Burden, socio-demographic and other risk factors associated with haemodialysis in North-west Nigeria: A retrospective multicentre analysis. Niger Postgrad Med J 2023; 30:200-209. [PMID: 37675696 DOI: 10.4103/npmj.npmj_80_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria. Methodology The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5-44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4-4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1-4.2]). Conclusion PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.
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Affiliation(s)
| | - Abubakar Mohammed Jibo
- Department of Community Medicine, Aminu Kano Teaching Hospital; Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | | | - Rabiu Ibrahim Jalo
- Department of Community Medicine, Aminu Kano Teaching Hospital; Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Fatimah Ismail Tsiga-Ahmed
- Department of Community Medicine, Aminu Kano Teaching Hospital; Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abubakar Musa
- Department of Community Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Salisu Muazu
- Department of Internal Medicine, Federal University Dutse, Dutse, Jigawa State, Nigeria
| | - Serawit Lisanework
- World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Luka Fitto Buba
- Department of Environmental Management, Bayero University Kano, Kano, Nigeria
| | - Kamalu Shehu Sidi
- Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Kabiru Abdulsalam
- Department of Chemical Pathology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
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Grange C, Aigle A, Ehrlich V, Salazar Ariza JF, Brichart T, Da Cruz-Boisson F, David L, Lux F, Tillement O. Design of a water-soluble chitosan-based polymer with antioxidant and chelating properties for labile iron extraction. Sci Rep 2023; 13:7920. [PMID: 37193699 DOI: 10.1038/s41598-023-34251-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
Loosely bound iron, due to its contribution to oxidative stress and inflammation, has become an important therapeutic target for many diseases. A water-soluble chitosan-based polymer exhibiting both antioxidant and chelating properties due to the dual functionalization with DOTAGA and DFO has been developed to extract this iron therefore preventing its catalytic production of reactive oxygen species. This functionalized chitosan was shown to have stronger antioxidant properties compared to conventional chitosan, improved iron chelating properties compared to the clinical therapy, deferiprone, and provided promising results for its application and improved metal extraction within a conventional 4 h hemodialysis session with bovine plasma.
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Affiliation(s)
- Coralie Grange
- MexBrain, 13 avenue Albert Einstein, Villeurbanne, France
- Institut Lumière-Matière, UMR 5306, Université Lyon1-CNRS, Université de Lyon, Villeurbanne Cedex, France
| | - Axel Aigle
- MexBrain, 13 avenue Albert Einstein, Villeurbanne, France
| | - Victor Ehrlich
- Institut Lumière-Matière, UMR 5306, Université Lyon1-CNRS, Université de Lyon, Villeurbanne Cedex, France
| | - Juan Felipe Salazar Ariza
- Institut Lumière-Matière, UMR 5306, Université Lyon1-CNRS, Université de Lyon, Villeurbanne Cedex, France
- Ingénierie des Matériaux Polymères, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Institut national des Sciences Appliquées, Université Jean Monnet, Univ Lyon, 15 bd Latarjet, 69622, Villeurbanne, France
- Institut Universitaire de France (IUF), 75231, Paris, France
| | | | - Fernande Da Cruz-Boisson
- Ingénierie des Matériaux Polymères, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Institut national des Sciences Appliquées, Université Jean Monnet, Univ Lyon, 15 bd Latarjet, 69622, Villeurbanne, France
| | - Laurent David
- Ingénierie des Matériaux Polymères, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Institut national des Sciences Appliquées, Université Jean Monnet, Univ Lyon, 15 bd Latarjet, 69622, Villeurbanne, France
| | - François Lux
- Institut Lumière-Matière, UMR 5306, Université Lyon1-CNRS, Université de Lyon, Villeurbanne Cedex, France.
- Institut Universitaire de France (IUF), 75231, Paris, France.
| | - Olivier Tillement
- Institut Lumière-Matière, UMR 5306, Université Lyon1-CNRS, Université de Lyon, Villeurbanne Cedex, France
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Acute Kidney Injury and Renal Replacement Therapy: A Review and Update for the Perioperative Physician. Anesthesiol Clin 2023; 41:211-230. [PMID: 36872000 DOI: 10.1016/j.anclin.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Post-operative acute kidney injury is a devastating complication with significant morbidity and mortality associated with it. The perioperative anesthesiologist is in a unique position to potentially mitigate the risk of postoperative AKI, however, understanding the pathophysiology, risk factors and preventative strategies is paramount. There are also certain clinical scenarios, where renal replacement therapy may be indicated intraoperatively including severe electrolyte abnormalities, metabolic acidosis and massive volume overload. A multidisciplinary approach including the nephrologist, critical care physician, surgeon and anesthesiologist is necessary to determine the optimal management of these critically ill patients.
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6
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Lin Y, Shao Y, Liu Y, Yang R, Liao S, Yang S, Xu M, He J. Efficacy and safety of nafamostat mesilate anticoagulation in blood purification treatment of critically ill patients: a systematic review and meta-analysis. Ren Fail 2022; 44:1263-1279. [PMID: 35930302 PMCID: PMC9359194 DOI: 10.1080/0886022x.2022.2105233] [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: 01/08/2023] Open
Abstract
Background Nafamostat mesilate (NM), a broad-spectrum and potent serine protease inhibitor, can be used as an anticoagulant during extracorporeal circulation, as well as a promising drug effective against coronavirus disease 2019 (COVID-19). We conducted a systematic meta-analysis to evaluate the safety and efficacy of NM administration in critically ill patients who underwent blood purification therapy (BPT). Methods The Cochrane Library, Web of Science and PubMed were comprehensively searched from inception to August 20, 2021, for potential studies. Results Four randomized controlled trials (RCTs) and seven observational studies with 2723 patients met the inclusion criteria. The meta-analysis demonstrated that conventional therapy (CT) significantly increased hospital mortality compared with NM administration (RR = 1.25, p = 0.0007). In subgroup analyses, the in-hospital mortality of the NM group was significantly lower than that of the anticoagulant-free (NA) group (RR = 1.31, p = 0.002). The CT interventions markedly elevated the risk ratio of bleeding complications by 45% (RR = 1.45, p = 0.010) compared with NM interventions. In another subgroup analysis, NM used exhibited a significantly lower risk of bleeding complications than those of the low-molecular-weight heparin (LMWH) used (RR = 4.58, p = 0.020). The filter lifespan was decreased significantly (MD = −10.59, p < 0.0001) in the NA groups compared with the NM groups. Due to the poor quality of the included RCTs, these results should be interpreted with caution. Conclusion Given the better survival outcomes, lower risk of bleeding, NM anticoagulation seems to be a safe and efficient approach for BPT patients and could yield a favorable filter lifespan. More multi-center RCTs with large samples are required for further validation of this study.
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Affiliation(s)
- Yao Lin
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Yiming Shao
- The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuchun Liu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Ruoxuan Yang
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Shuanglin Liao
- The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Shuai Yang
- The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Mingwei Xu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Junbing He
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
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7
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Qiao J, Cui L. Multi-Omics Techniques Make it Possible to Analyze Sepsis-Associated Acute Kidney Injury Comprehensively. Front Immunol 2022; 13:905601. [PMID: 35874763 PMCID: PMC9300837 DOI: 10.3389/fimmu.2022.905601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/10/2022] [Indexed: 12/29/2022] Open
Abstract
Sepsis-associated acute kidney injury (SA-AKI) is a common complication in critically ill patients with high morbidity and mortality. SA-AKI varies considerably in disease presentation, progression, and response to treatment, highlighting the heterogeneity of the underlying biological mechanisms. In this review, we briefly describe the pathophysiology of SA-AKI, biomarkers, reference databases, and available omics techniques. Advances in omics technology allow for comprehensive analysis of SA-AKI, and the integration of multiple omics provides an opportunity to understand the information flow behind the disease. These approaches will drive a shift in current paradigms for the prevention, diagnosis, and staging and provide the renal community with significant advances in precision medicine in SA-AKI analysis.
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Affiliation(s)
- Jiao Qiao
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
- Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Liyan Cui
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
- Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, China
- *Correspondence: Liyan Cui,
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8
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Somaili M. Early versus Delayed Strategies for Renal Replacement Therapy Initiation in Adult Patients with Severe Acute Kidney Injury Complicating Septic Shock: A Systematic Review and Meta-analysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:449-486. [PMID: 37843147 DOI: 10.4103/1319-2442.385969] [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: 10/17/2023] Open
Abstract
Sepsis-associated acute kidney injury (AKI) is a frequent complication in hospitalized patients and is associated with significant morbidity and mortality. Renal replacement therapy (RRT) is used to manage AKI. The optimal timing of starting RRT in patients with AKI is still uncertain. This study is aimed to assess the effect of different timing strategies of RRT (early vs. standard) on mortality and dependence on dialysis in severe AKI complicating septic shock. A systematic review was conducted using the Ovid Medline database, trial registries, and manual searches of key journals from January 2000 to October 2020. Appropriate outcomes were pooled and analyzed via a meta-analysis. Only randomized controlled trials (RCTs) were included to compare between the early vs. delayed strategies of RRT. The inverse generic method was used, and the data were pooled using random effects. Five studies were included in this review, with 4329 participants. Overall, most domains were assessed as low-risk or with some concerns about the risk of bias. Compared with standard therapy, early initiation probably results in little or no difference regarding death, and may also result in no or little difference in independence on dialysis. The early strategy may result in a slight increase in adverse events. Compared with the standard strategy, earlier RRT initiation may slightly reduce the length of hospital stay. Further RCTs are needed to define the optimal timing of RRT initiation in this population.
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Affiliation(s)
- Mohammed Somaili
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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9
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Zhang N, Zhang F, Chen Z, Huang R, Xia J, Liu J. Successful treatment of linezolid-induced severe lactic acidosis with continuous venovenous hemodiafiltration: A case report. Saudi Pharm J 2022; 30:108-111. [PMID: 35528852 PMCID: PMC9072705 DOI: 10.1016/j.jsps.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/27/2021] [Indexed: 12/29/2022] Open
Abstract
Linezolid is an oxazolidinone antibiotic. Linezolid-associated lactic acidosis has been reported in 6.8% of linezolid-treated patients. Lactic acidosis is associated with poor clinical outcomes, with high blood lactate levels resulting in organ dysfunction and mortality. This case report describes the development of lactic acidosis in a 64-year-old Chinese woman who had received 33 days of treatment with antituberculosis drugs and 28 days of treatment with oral linezolid for tuberculous meningitis. Severe lactic acidosis was reversed by withdrawing antituberculosis drugs and using continuous venovenous hemodiafiltration (CVVH). When the patient's condition was stable, she was transferred to the infectious disease department, and antituberculosis drugs, with the exception of linezolid, were reintroduced. This did not result in recurrence of lactic acidosis. The causal relationship between lactic acidosis and linezolid was categorized as 'probable' on the Adverse Drug Reaction Probability Scale. This case demonstrates that CVVH has potential as an alternative to discontinuation of linezolid alone for rapid reversal of linezolid-associated severe lactic acidosis.
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Key Words
- ADR, Adverse Drug Reaction
- APTT, activated partial thromboplastin time
- CRRT, continuous renal replacement therapy
- CVVH
- CVVH, continuous venovenous hemodiafiltration
- Case report
- ESRD, end-stage renal disease
- FIB, fibrinogen
- ICU, intensive care unit
- Lactic acidosis
- Linezolid
- PT, prothrombin time
- PaCO2, arterial partial pressure of carbon dioxide
- PaO2, arterial partial pressure of oxygen
- TT, thrombin time
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Affiliation(s)
- Naiju Zhang
- Department of Pharmacy, Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Key Laboratory of Immunology in Chronic Diseases, The first Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, China
| | - Fan Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, Nanjing 210008, PR China
| | - Zhong Chen
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, Nanjing 210008, PR China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, Nanjing 210008, PR China
| | - Juan Xia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, Nanjing 210008, PR China
- Corresponding authors at: Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, NO.321 Zhongshan Road, Jiangsu, Nanjing 210008, PR China.
| | - Jinchun Liu
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Medical Center for Clinical Pharmacy, Jiangsu, Nanjing 210008, PR China
- Corresponding authors at: Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, NO.321 Zhongshan Road, Jiangsu, Nanjing 210008, PR China.
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10
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Jawa NA, Holden RM, Silver SA, Scott SH, Day AG, Norman PA, Kwan BYM, Maslove DM, Muscedere J, Boyd JG. Identifying neurocognitive outcomes and cerebral oxygenation in critically ill adults on acute kidney replacement therapy in the intensive care unit: the INCOGNITO-AKI study protocol. BMJ Open 2021; 11:e049250. [PMID: 34404711 PMCID: PMC8372874 DOI: 10.1136/bmjopen-2021-049250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Initiation of acute kidney replacement therapy (KRT) is common in critically ill adults admitted to the intensive care unit (ICU), and associated with increased morbidity and mortality. KRT has been linked to poor neurocognitive outcomes, leading to reduced quality of life and increased utilisation of healthcare resources. Adults on dialysis in the ICU may be particularly at risk of neurocognitive impairment, as survivors of critical illness are already predisposed to developing cerebrovascular disease and cognitive dysfunction long-term relative to healthy controls. Regional cerebral oxygen saturation may provide a critical early marker of long-term neurocognitive impairment in this population. This study aims to understand cerebral oxygenation in patients undergoing KRT (continuous or intermittent) in the ICU. These findings will be correlated with long-term cognitive and functional outcomes, and structural brain pathology. METHODS AND ANALYSIS 108 patients scheduled to undergo treatment for acute kidney injury with KRT in the Kingston Health Sciences Centre ICU will be recruited into this prospective observational study. Enrolled patients will be assessed with intradialytic cerebral oximetry using near infrared spectroscopy. Delirium will be assessed daily with the Confusion Assessment Method-ICU (CAM-ICU) and severity quantified as cumulative CAM-ICU-7 scores. Neurocognitive impairment will be assessed at 3 and 12 months after hospital discharge using the Kinarm and Repeatable Battery for the Assessment of Neuropsychological Status. Structural brain pathology on MRI will also be measured at the same timepoints. Driving safety, adverse events and medication adherence will be assessed at 12 months to evaluate the impact of neurocognitive impairment on functional outcomes. ETHICS AND DISSEMINATION This study is approved by the Queen's University Health Sciences/Affiliated Teaching Hospitals Research Ethics Board (DMED-2424-20). Results will be presented at critical care conferences, and a lay summary will be provided to patients in their preferred format. TRIAL REGISTRATION NUMBER NCT04722939.
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Affiliation(s)
| | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Samuel A Silver
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Kingston General Health Research Institute, Kingston, Ontario, Canada
| | - Patrick A Norman
- Kingston General Health Research Institute, Kingston, Ontario, Canada
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - David M Maslove
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - John Muscedere
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - John Gordon Boyd
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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11
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Constantinescu C, Pasca S, Tat T, Teodorescu P, Vlad C, Iluta S, Dima D, Tomescu D, Scarlatescu E, Tanase A, Sigurjonsson OE, Colita A, Einsele H, Tomuleasa C. Continuous renal replacement therapy in cytokine release syndrome following immunotherapy or cellular therapies? J Immunother Cancer 2021; 8:jitc-2020-000742. [PMID: 32474415 PMCID: PMC7264828 DOI: 10.1136/jitc-2020-000742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
Recently, an increasing number of novel drugs were approved in oncology and hematology. Nevertheless, pharmacology progress comes with a variety of side effects, of which cytokine release syndrome (CRS) is a potential complication of some immunotherapies that can lead to multiorgan failure if not diagnosed and treated accordingly. CRS generally occurs with therapies that lead to highly activated T cells, like chimeric antigen receptor T cells or in the case of bispecific T-cell engaging antibodies. This, in turn, leads to a proinflammatory state with subsequent organ damage. To better manage CRS there is a need for specific therapies or to repurpose strategies that are already known to be useful in similar situations. Current management strategies for CRS are represented by anticytokine directed therapies and corticosteroids. Based on its pathophysiology and the resemblance of CRS to sepsis and septic shock, as well as based on the principles of initiation of continuous renal replacement therapy (CRRT) in sepsis, we propose the rationale of using CRRT therapy as an adjunct treatment in CRS where all the other approaches have failed in controlling the clinically significant manifestations.
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Affiliation(s)
- Catalin Constantinescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Anesthesia - Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Tiberiu Tat
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Catalin Vlad
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Dana Tomescu
- Department of Anesthesia - Intensive Care, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania.,Department of Anesthesia - Intensive Care, Fundeni Clinical Institute, Bucuresti, Romania
| | - Ecaterina Scarlatescu
- Department of Stem Cell Transplantation, Clinical Institute Fundeni, Bucuresti, Romania
| | - Alina Tanase
- Department of Stem Cell Transplantation, Clinical Institute Fundeni, Bucuresti, Romania
| | - Olafur Eysteinn Sigurjonsson
- University of Reykjavik, Reykjavik, Iceland.,Bloodbank, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Anca Colita
- Department of Stem Cell Transplantation, Clinical Institute Fundeni, Bucuresti, Romania
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Wurzburg, Bayern, Germany
| | - Ciprian Tomuleasa
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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Hiramatsu T, Shimizu S, Koga H. Prognostic factors in patients treated with extracorporeal membrane oxygenation and continuous renal replacement therapy. Perfusion 2021; 37:570-574. [PMID: 33870783 DOI: 10.1177/02676591211011039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) and Continuous renal replacement therapy (CRRT) are treatments for critically ill patients with respiratory failure and acute kidney injury. However, no reliable factors have been identified to predict survival in patients treated with both ECMO and CRRT. The aim of this study was to identify prognostic factors for discharging intensive care unit (ICU) patients who required CRRT during ECMO. METHODS We retrospectively analyzed data from patients who required CRRT in addition to the ECMO, between April 2015 and March 2018. The patients were divided into two groups: patients who survived and patients who died during ICU hospitalization. We determined their demographic and clinical characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Simplified Acute Physiology Score II (SAPS II) scores, and sequential organ failure assessment (SOFA) scores. Further, we assessed whether these characteristics differed between individuals who did or did not survive the ICU hospitalization. RESULTS We found that the APACHE II and SAPS II scores differed significantly between both ECMO and CRRT treated patients who did or did not survive hospitalization. Further, intracranial hemorrhage during ECMO and CRRT therapy was associated with lower survival rate. CONCLUSIONS Using APACHE II and SAPS II scores might be helpful in making treatment decisions for patients treated with ECMO and CRRT. Intracranial hemorrhage could be a poor prognostic factor. Our findings indicate the potential utility of APACHE II and SAPS II scores to predict mortality in patients treated with both ECMO and CRRT.
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Affiliation(s)
- Toshiki Hiramatsu
- Department of Critical Care Medicine, ASO Iizuka Hospital, Iizuka city, Fukuoka, Japan
| | - Shigemitsu Shimizu
- Department of Clinical Engineering, ASO Iizuka Hospital, Iizuka city, Fukuoka, Japan
| | - Hidenobu Koga
- Clinical Research Support Office, ASO Iizuka Hospital, Iizuka city, Fukuoka, Japan
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Gisewhite S, Stewart IJ, Beilman G, Lusczek E. Urinary metabolites predict mortality or need for renal replacement therapy after combat injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:119. [PMID: 33757577 PMCID: PMC7988986 DOI: 10.1186/s13054-021-03544-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Traditionally, patient risk scoring is done by evaluating vital signs and clinical severity scores with clinical intuition. Urinary biomarkers can add objectivity to these models to make risk prediction more accurate. We used metabolomics to identify prognostic urinary biomarkers of mortality or need for renal replacement therapy (RRT). Additionally, we assessed acute kidney injury (AKI) diagnosis, injury severity score (ISS), and AKI stage. METHODS Urine samples (n = 82) from a previous study of combat casualties were evaluated using proton nuclear magnetic resonance (1H-NMR) spectroscopy. Chenomx software was used to identify and quantify urinary metabolites. Metabolite concentrations were normalized by urine output, autoscaled, and log-transformed. Partial least squares discriminant analysis (PLS-DA) and statistical analysis were performed. Receiver operating characteristic (ROC) curves were used to assess prognostic utility of biomarkers for mortality and RRT. RESULTS Eighty-four (84) metabolites were identified and quantified in each urine sample. Of these, 11 were identified as drugs or drug metabolites and excluded. The PLS-DA models for ISS and AKI diagnosis did not have acceptable model statistics. Therefore, only mortality/RRT and AKI stage were analyzed further. Of 73 analyzed metabolites, 9 were significantly associated with mortality/RRT (p < 0.05) and 11 were significantly associated with AKI stage (p < 0.05). 1-Methylnicotinamide was the only metabolite to be significantly associated (p < 0.05) with all outcomes and was significantly higher (p < 0.05) in patients with adverse outcomes. Elevated lactate and 1-methylnicotinamide levels were associated with higher AKI stage and mortality and RRT, whereas elevated glycine levels were associated with patients who survived and did not require RRT, or had less severe AKI. ROC curves for each of these metabolites and the combined panel had good predictive value (lactate AUC = 0.901, 1-methylnicotinamide AUC = 0.864, glycine AUC = 0.735, panel AUC = 0.858). CONCLUSIONS We identified urinary metabolites associated with AKI stage and the primary outcome of mortality or need for RRT. Lactate, 1-methylnicotinamide, and glycine may be used as a panel of predictive biomarkers for mortality and RRT. 1-Methylnicotinamide is a novel biomarker associated with adverse outcomes. Additional studies are necessary to determine how these metabolites can be utilized in clinically-relevant risk prediction models.
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Affiliation(s)
- Sarah Gisewhite
- Department of Surgery, University of Minnesota, 515 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Greg Beilman
- Department of Surgery, University of Minnesota, 515 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Elizabeth Lusczek
- Department of Surgery, University of Minnesota, 515 Delaware St SE, Minneapolis, MN, 55455, USA
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Garg N, Kumar V, Sohal PM, Jain D, Jain A, Mehta S. Efficacy and outcome of intermittent peritoneal dialysis in patients with acute kidney injury: A single-center experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:423-430. [PMID: 32394915 DOI: 10.4103/1319-2442.284017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There are only a few reports on the role of peritoneal dialysis (PD) in critically ill patients requiring continuous renal replacement therapies (RRT). This study aimed to determine the efficacy and outcome of intermittent PD in acute kidney injury (AKI) patients in intensive care unit setting and to assess the procedure-related complications. This was a prospective, observational study conducted from March 1, 2015, to February 29, 2016, which included patients of either sex, aged ≥18 years, diagnosed with AKI, and undergoing RRT with intermittent PD sessions with more than 48 h of hospital stay. Patients were later shifted to sustained low- efficiency dialysis or hemodialysis, when they became hemodynamically stable. Hence, the patients who received at least 48 h of PD were included in the study. A total of 75 patients were enrolled. Overall, the mean age was 55.75 years, and around 64% were men. The most common indication to start PD was metabolic acidosis, and the most common cause of AKI was sepsis. A total of 21 patients survived, and the mortality rate was 72%. The average peritoneal urea clearance and creatinine clearance were 14.81 mL/min and 12.59 mL/min, respectively. Of the 66 patients on inotropes, 28 patients were tapered from inotropic support. Thirty-nine patients had hyperkalemia, and 27 patients had correction within 1 day of the start of PD. Forty-seven patients had correction of acidosis, and 33 of these achieved pH ≥7.25 within one day of PD. The most common complication that occurred was peri-catheter leaks followed by peritonitis. Acute PD can be an effective, simple, and safe bridge RRT in hemodynamically unstable patients until the achievement of hemodynamic stability to shift them to other modalities of RRT.
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Affiliation(s)
- Nitish Garg
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vipin Kumar
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Preet Mohinder Sohal
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dinesh Jain
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aayush Jain
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sudhir Mehta
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Agapito Fonseca J, Gameiro J, Marques F, Lopes JA. Timing of Initiation of Renal Replacement Therapy in Sepsis-Associated Acute Kidney Injury. J Clin Med 2020; 9:jcm9051413. [PMID: 32397637 PMCID: PMC7290350 DOI: 10.3390/jcm9051413] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Sepsis-associated acute kidney injury (SA-AKI) is a major issue in medical, surgical and intensive care settings and is an independent risk factor for increased mortality, as well as hospital length of stay and cost. SA-AKI encompasses a proper pathophysiology where renal and systemic inflammation play an essential role, surpassing the classic concept of acute tubular necrosis. No specific treatment has been defined yet, and renal replacement therapy (RRT) remains the cornerstone supportive therapy for the most severe cases. The timing to start RRT, however, remains controversial, with early and late strategies providing conflicting results. This article provides a comprehensive review on the available evidence on the timing to start RRT in patients with SA-AKI.
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Lee KH, Sol IS, Park JT, Kim JH, Shin JW, Park MR, Lee JH, Kim YH, Kim KW, Shin JI. Continuous Renal Replacement Therapy (CRRT) in Children and the Specialized CRRT Team: A 14-Year Single-Center Study. J Clin Med 2019; 9:jcm9010110. [PMID: 31906191 PMCID: PMC7019966 DOI: 10.3390/jcm9010110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 11/23/2022] Open
Abstract
Continuous renal replacement therapy (CRRT) has been used as an important intervention in critically ill children. Our center has the only specialized CRRT team (SCT) for children in Korea, which consists of pediatric intensivists, a pediatric nephrologist and CRRT-specialized-nurses. This study was a retrospective single-center analysis, including all pediatric patients admitted to the intensive care unit (ICU) of Severance hospital in Korea and received CRRT between 2003 and 2016, grouped as before SCT (group A, n = 51) and after SCT (group B, n = 212). We obtained the data for sex, age, weight, diagnosis, blood flow rate or type of CRRT machine used, administration of inotropic agents or anticoagulants, and ICU duration before CRRT (hours). A total of 263 patients were included. The age was significantly younger (p < 0.001) and blood flow rate was lower (p = 0.001) in group B than group A. Vasopressors (p < 0.001), continuous veno-venous hemodiafiltration (CVVHDF) (p < 0.001), nafamostat mesilate (p < 0.001), and extracorporeal membrane oxygenation (ECMO)-CRRT (p = 0.004) were more frequently used in group B. Based on our 14-year experience, we conclude that SCT operation could have played an important role in increasing the amount of CRRT utilization.
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Affiliation(s)
- Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea; (K.H.L.); (J.H.K.); (J.W.S.); (M.R.P.); (J.H.L.)
- Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - In Suk Sol
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (I.S.S.); (Y.H.K.)
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Sakju-ro 77, Gangwon-do, Chuncheon 24253, Korea
| | - Jung Tak Park
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea;
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Ji Hong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea; (K.H.L.); (J.H.K.); (J.W.S.); (M.R.P.); (J.H.L.)
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul 06273, Korea
| | - Jae Won Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea; (K.H.L.); (J.H.K.); (J.W.S.); (M.R.P.); (J.H.L.)
| | - Mi Rireu Park
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea; (K.H.L.); (J.H.K.); (J.W.S.); (M.R.P.); (J.H.L.)
| | - Jae Hyun Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea; (K.H.L.); (J.H.K.); (J.W.S.); (M.R.P.); (J.H.L.)
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (I.S.S.); (Y.H.K.)
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul 06273, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (I.S.S.); (Y.H.K.)
- Correspondence: (K.W.K.); (J.I.S.)
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea; (K.H.L.); (J.H.K.); (J.W.S.); (M.R.P.); (J.H.L.)
- Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: (K.W.K.); (J.I.S.)
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Farhat A, Grigorian A, Nguyen NT, Smith B, Williams BJ, Schubl SD, Joe V, Elfenbein D, Nahmias J. Obese trauma patients have increased need for dialysis. Eur J Trauma Emerg Surg 2019; 46:1327-1334. [PMID: 31111163 DOI: 10.1007/s00068-019-01147-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/11/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Obesity is a risk factor for the development of acute kidney injury but its effect on the need for dialysis in trauma has not been elucidated. Additionally, the contribution that obesity has towards risk of mortality in trauma is unclear. We hypothesized that patients with a higher body mass index (BMI) will have a higher risk for need of dialysis and mortality after trauma. METHODS This is a retrospective analysis using the National Trauma Data Bank. All patients ≥ 8 years old were grouped based on BMI: normal (18.5-24.99 kg/m2), obese (30-34.99 kg/m2), severely obese (35-39.99 kg/m2) and morbidly obese (≥ 40 kg/m2). The primary outcome was hemodialysis initiation. The secondary outcome was mortality during the index hospitalization. RESULTS From 988,988 trauma patients, 571,507 (57.8%) had a normal BMI, 233,340 (23.6%) were obese, 94,708 (9.6%) were severely obese, and 89,433 (9.0%) were morbidly obese. The overall rate of hemodialysis was 0.3%. After adjusting for covariates, we found that obese (OR 1.36, CI 1.22-1.52, p < 0.001), severely obese (OR 1.89, CI 1.66-2.15, p < 0.001) and morbidly obese (OR 2.04, CI 1.82-2.29, p < 0.001) patients had a stepwise increased need for hemodialysis after trauma. Obese patients had decreased (OR 0.92, CI 0.88-0.95, p < 0.001), severely obese had similar (OR 1.02, CI 0.97-1.08, p = 0.50) and morbidly obese patients had increased (OR 1.06, CI 1.01-1.12, p = 0.011) risk of mortality after trauma. CONCLUSIONS Obesity was associated with an increased risk for dialysis after trauma. Mortality risk was reduced in obese, similar in severely obese, and increased in morbidly obese trauma patients suggesting an inflection threshold BMI for risk of mortality in trauma.
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Affiliation(s)
- Ahmed Farhat
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Ninh T Nguyen
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Brian Smith
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Barbara J Williams
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Sebastian D Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Victor Joe
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Dawn Elfenbein
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
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Abd Samad MI, Kayani AA, Zoolfakar AS, Hamzah AA, Majlis BY, Buyong MR. Lab-on-a-chip Dielectrophoretic Manipulation of Beta-2 Microglobulin for Toxin Removal in An Artificial Kidney. MICRO AND NANOSYSTEMS 2019; 11:40-46. [DOI: 10.2174/1876402911666181218145459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 09/02/2023]
Abstract
Background:
This paper presents a fundamental study of protein manipulation under the
influence of dielectrophoretic (DEP) force for a lab-on-a-chip platform.
Objective:
Protein manipulation is dependent on the polarisation factor of protein when exposed to an
electric field. Therefore the objective of this work is a microfluidic device and measurement system
are used to characterise the human beta-2 microglobulin (β2M) protein via lateral attractive forces and
vertical repulsive forces by means of DEP responses.
Method:
The manipulation of the β2M protein was conducted using a microfluidic platform with a tapered
DEP microelectrode and the protein concentration was quantified based on a biochemical interaction
using an Enzyme-Linked Immunosolvent Assay (ELISA). The protein distribution has been analysed
based on the β2M concentration for each microfluidic outlet.
Results:
At 300 kHz, the protein experienced a negative DEP (nDEP) with of 83.3% protein distribution
on the middle microchannel. In contrast, the protein experienced a positive DEP (pDEP) at 1.2
MHz with of 78.7% of protein on the left and right sides of the microchannel.
Conclusion:
This is concept proved that the tapered DEP microelectrode is capable of manipulating
a β2M via particle polarisation, hence making it suitable to be utilised for purifying proteins in biomedical
application.
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Affiliation(s)
- Muhammad Izzuddin Abd Samad
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
| | - Aminuddin Ahmad Kayani
- Center for Advanced Materials and Green Technology, Multimedia University, 75450 Melaka, Malaysia
| | - Ahmad Sabirin Zoolfakar
- NANOElecTronic Centre, NET, Universiti Teknologi Mara, UiTM, Shah Alam 45450, Selangor, Malaysia
| | - Azrul Azlan Hamzah
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
| | - Burhanuddin Yeop Majlis
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
| | - Muhamad Ramdzan Buyong
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
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Yehl CJ, Jabra MG, Zydney AL. Hollow fiber countercurrent dialysis for continuous buffer exchange of high‐value biotherapeutics. Biotechnol Prog 2018; 35:e2763. [DOI: 10.1002/btpr.2763] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/03/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher J. Yehl
- Dept. of Chemical EngineeringThe Pennsylvania State University University Park PA, 16802
| | - Mario G. Jabra
- Dept. of Chemical EngineeringThe Pennsylvania State University University Park PA, 16802
| | - Andrew L. Zydney
- Dept. of Chemical EngineeringThe Pennsylvania State University University Park PA, 16802
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Lu YW, Lu SF, Chou RH, Wu PS, Ku YC, Kuo CS, Chang CC, Tsai YL, Wu CH, Huang PH. Lipid paradox in patients with acute myocardial infarction: Potential impact of malnutrition. Clin Nutr 2018; 38:2311-2318. [PMID: 30482563 DOI: 10.1016/j.clnu.2018.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/04/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Aggressive lipid reduction is recommended for patients with AMI, but reverse epidemiology, the lipid paradox, has been reported in several clinical studies. The cause of lipid paradox remains uncertain, and nutrition is one possible explanation. In this single-center retrospective study, we investigated the relationships between baseline LDL concentrations and clinical outcomes in patients with AMI, stratified by different nutritional status. METHODS Totally 409 patients were enrolled for analysis. The Nutritional Risk Index (NRI) was used to estimate the risk of malnutrition. Subjects were grouped into tertiles according to their NRIs. Clinical outcomes were compared among patients with varying NRIs and LDL levels. RESULTS Patients in the lowest NRI tertile had increased incidences of in-hospital mortality, cardiogenic shock, decompensated heart failure, renal failure, and sepsis. This tertile was also associated with increased long-term mortality during the follow-up period of 832 ± 744 days. Mortality was increased among patients with baseline LDL concentrations ≤70 mg/dL in the lowest NRI tertile (log rank test, p = 0.0257), but not in the high or median tertiles. Moreover, baseline LDL level ≤70 mg/dL was an independent risk factor of all-cause mortality (adjusted hazard ratio = 1.73; 95% confidence interval, 1.01-2.94; p = 0.045) in the lowest NRI tertile. CONCLUSIONS Lipid paradox was observed in the high-risk of malnutrition population among patients with AMI. Aggressive lipid-lowering therapy is still recommended for patients with AMI and fair nutritional status. However, when treating patients at high risk of malnutrition, the improvement of nutritional status may be more beneficial than strict LDL control.
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Affiliation(s)
- Ya-Wen Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Fen Lu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Shan Wu
- Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chen Ku
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Sung Kuo
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Chin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Tuerdi B, Zuo L, Sun H, Wang K, Wang Z, Li G. Safety and efficacy of regional citrate anticoagulation in continuous blood purification treatment of patients with multiple organ dysfunction syndrome. Braz J Med Biol Res 2017; 51:e6378. [PMID: 29185591 PMCID: PMC5685057 DOI: 10.1590/1414-431x20176378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/23/2017] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall's MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups. RCA resulted in lower blood pressure than hfBP. The filter efficacy in RCA treatment was longer than in the hfBP group. The blood clearance of creatine, blood urea nitrogen and uric acid was better in the RCA group. RCA also led to higher pH than hfBP. Neither treatment resulted in severe bleeding events. In addition, MODS score was positively correlated with prothrombin time and activated partial thromboplastin time but negatively correlated with platelet concentration. RCA is a safer and more effective method in CBP treatment; however, it could also lead to low blood pressure and blood alkalosis.
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Affiliation(s)
- B. Tuerdi
- Respiratory Intensive Care Units, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - L. Zuo
- Respiratory Intensive Care Units, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - H. Sun
- Respiratory Intensive Care Units, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - K. Wang
- Respiratory Intensive Care Units, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Z. Wang
- Intensive Care Units, Branch of the First Affiliated Hospital of Xinjiang Medical University, Changji, Xinjiang, China
| | - G. Li
- Intensive Care Units, Branch of the First Affiliated Hospital of Xinjiang Medical University, Changji, Xinjiang, China
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Vargas N, Tibullo L, Landi E, Carifi G, Pirone A, Pippo A, Alviggi I, Tizzano R, Salsano E, Di Grezia F, Vargas M. Caring for critically ill oldest old patients: a clinical review. Aging Clin Exp Res 2017; 29:833-845. [PMID: 27761759 DOI: 10.1007/s40520-016-0638-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
Abstract
Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.
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Affiliation(s)
- Nicola Vargas
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy.
| | - Loredana Tibullo
- Medicine Ward, Medicine Department, "San Giuseppe Moscati" Hospital, via Gramsci, 81031, Aversa, CE, Italy
| | - Emanuela Landi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Giovanni Carifi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Alfonso Pirone
- Clinical Nutrition and Dietology Unit, Medicine Department, Azienda Ospedaliera di Rilievo Nazionale e di alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Antonio Pippo
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Immacolata Alviggi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Renato Tizzano
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Elisa Salsano
- Department of Clinical Disease and Internal Medicine, Federico II University of Naples, via Pansini, 80121, Naples, Italy
| | - Francesco Di Grezia
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Maria Vargas
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini, 89121, Naples, Italy
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Kao CC, Yang JY, Chen L, Chao CT, Peng YS, Chiang CK, Huang JW, Hung KY. Factors associated with poor outcomes of continuous renal replacement therapy. PLoS One 2017; 12:e0177759. [PMID: 28542272 PMCID: PMC5443525 DOI: 10.1371/journal.pone.0177759] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/03/2017] [Indexed: 12/16/2022] Open
Abstract
Continuous renal replacement therapy (CRRT) is one of the dialysis modalities for critically ill patients. Despite intensive dialysis care, a high mortality rate is found in these patients. Our objective was to investigate the factors associated with poor outcomes in these patients. We conducted a retrospective cohort study using the National Health Insurance Research Database. Records of critically ill patients who received CRRT between 2007 and 2011 were retrieved, and the patients were categorized into two groups: those with acute kidney injury (AKI) and those with history of end-stage renal disease (ESRD). Our primary and secondary outcomes were in-hospital mortality and long-term survival and non-renal recovery (long-term dialysis dependence), respectively, in the AKI group. We enrolled 15,453 patients, with 13,204 and 2249 in the AKI and ESRD groups, respectively. Overall, 66.5% patients died during hospitalization. In-hospital mortality did not differ significantly between groups (adjusted odds ratio, 0.93; 95% CI, 0.84–1.02). Age, chronic liver disease, and cancer history were identified as independent risk factors for in-hospital mortality in both groups. Hypertension was associated with higher risk of in-hospital mortality in patients with AKI. Age, coronary artery disease, and admission to the medical intensive care unit (MICU) were risk factors for long-term dialysis dependence in patients with AKI. Patients with AKI and ESRD have similarly poor outcomes after CRRT. Older age and presence of chronic liver disease and cancer were associated with higher mortality. Older age, presence of coronary artery disease, and admission to MICU were associated with lower renal recovery rate in patients with AKI.
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Affiliation(s)
- Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ju-Yeh Yang
- Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Quality Management Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Industrial Management, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Likwang Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Sen Peng
- Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Kang Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Schoenfelder T, Chen X, Bleß HH. Effects of continuous and intermittent renal replacement therapies among adult patients with acute kidney injury. GMS HEALTH TECHNOLOGY ASSESSMENT 2017; 13:Doc01. [PMID: 28326146 PMCID: PMC5332811 DOI: 10.3205/hta000127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Dialysis-dependent acute kidney injury (AKI) can be treated using continuous (CRRT) or intermittent renal replacement therapies (IRRT). Although some studies suggest that CRRT may have advantages over IRRT, study findings are inconsistent. This study assessed differences between CRRT and IRRT regarding important clinical outcomes (such as mortality and renal recovery) and cost-effectiveness. Additionally, ethical aspects that are linked to renal replacement therapies in the intensive care setting are considered. Methods: Systematic searches in MEDLINE, EMBASE, and Cochrane Library including RCTs, observational studies, and cost-effectiveness studies were performed. Results were pooled using a random effects-model. Results: Forty-nine studies were included. Findings show a higher rate of renal recovery among survivors who initially received CRRT as compared with IRRT. This advantage applies to the analysis of all studies with different observation periods (Relative Risk (RR) 1.10; 95% Confidence Interval (CI) [1.05, 1.16]) and to a selection of studies with observation periods of 90 days (RR 1.07; 95% CI [1.04, 1.09]). Regarding observation periods beyond there are no differences when only two identified studies were analyzed. Patients initially receiving CRRT have higher mortality as compared to IRRT (RR 1.17; 95% CI [1.06, 1.28]). This difference is attributable to observational studies and may have been caused by allocation bias since seriously ill patients more often initially receive CRRT instead of IRRT. CRRT do not significantly differ from IRRT with respect to change of mean arterial pressure, hypotensive episodes, hemodynamic instability, and length of stay. Data on cost-effectiveness is inconsistent. Recent analyzes indicate that initial CRRT is cost-effective compared to initial IRRT due to a reduction of the rate of long-term dialysis dependence. As regards a short time horizon, this cost benefit has not been shown. Conclusion: Findings of the conducted assessment show that initial CRRT is associated with higher rates of renal recovery. Potential long-term effects on clinical outcomes for more than three months could not be analyzed and should be investigated in further studies. Economical analyzes indicate that initial CRRT is cost-effective when costs of long-term dialysis dependence are considered. However, transferability of the economic analyzes to the German health care system is limited and the conduction of economical analyzes using national cost data should be considered.
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Xu X, Khadzhynov D, Peters H, Chaves RL, Hamed K, Levi M, Corti N. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy. Br J Clin Pharmacol 2016; 83:498-509. [PMID: 27628437 PMCID: PMC5306496 DOI: 10.1111/bcp.13131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/22/2016] [Accepted: 09/06/2016] [Indexed: 12/11/2022] Open
Abstract
Aim The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). Methods A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno‐venous haemodialysis (CVVHD; n = 9) and continuous veno‐venous haemodiafiltration (CVVHDF; n = 8). Model‐based simulations were performed to compare the 24 h AUC, Cmax and Cmin of daptomycin following various dosing regimens (4, 6, 8, 10, and 12 mg kg−1 every [Q] 24 h and Q48 h), with the safety and efficacy exposure references for Staphylococcus aureus bacteraemia/right‐sided infective endocarditis. Results The previously developed daptomycin structural population PK model could reasonably describe data from the patients on CRRT. The clearance in patients undergoing CVVHDF and CVVHD was estimated at 0.53 and 0.94 l h−1, respectively, as compared with 0.75 l h−1 in patients with creatinine clearance (CrCl) ≥ 30 ml min−1. Daptomycin Q24 h dosing in patients undergoing CRRT resulted in optimal exposure for efficacy, with AUC comparable to that in patients with CrCl ≥ 30 ml min−1. In contrast, Q48 h dosing was associated with considerably lower AUC24–48h in all patients for doses up to 12 mg kg−1 and is therefore inappropriate. Conclusions Q24 h dosing of daptomycin up to 12 mg kg−1 provides comparable drug exposure in patients on CVVHD and in those with CrCl ≥ 30 ml min−1. Daily daptomycin use up to 8 mg kg−1 doses are appropriate for patients on CVVHDF, but higher doses may increase the risk of toxicity.
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Affiliation(s)
- Xiaoying Xu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Dmytro Khadzhynov
- Department of Nephrology, Charité Campus Mitte, Charité - Universitätsmedizin, Berlin, Germany
| | - Harm Peters
- Department of Nephrology, Charité Campus Mitte, Charité - Universitätsmedizin, Berlin, Germany.,Dieter Scheffner Center for Medical Education and Educational Research, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Micha Levi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Natascia Corti
- Department of Clinical Pharmacology and Toxicology, Zurich University Hospital, Zurich, Switzerland
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Clinical Validation of Therapeutic Drug Monitoring of Imipenem in Spent Effluent in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Pilot Study. PLoS One 2016; 11:e0153927. [PMID: 27093294 PMCID: PMC4836878 DOI: 10.1371/journal.pone.0153927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/06/2016] [Indexed: 12/29/2022] Open
Abstract
Objectives The primary objective of this pilot study was to investigate whether the therapeutic drug monitoring of imipenem could be performed with spent effluent instead of blood sampling collected from critically ill patients under continuous renal replacement therapy. Methods A prospective open-label study was conducted in a real clinical setting. Both blood and effluent samples were collected pairwise before imipenem administration and 0.5, 1, 1.5, 2, 3, 4, 6, and 8 h after imipenem administration. Plasma and effluent imipenem concentrations were determined by reversed-phase high-performance liquid chromatography with ultraviolet detection. Pharmacokinetic and pharmacodynamic parameters of blood and effluent samples were calculated. Results Eighty-three paired plasma and effluent samples were obtained from 10 patients. The Pearson correlation coefficient of the imipenem concentrations in plasma and effluent was 0.950 (P<0.0001). The average plasma-to-effluent imipenem concentration ratio was 1.044 (95% confidence interval, 0.975 to 1.114) with Bland-Altman analysis. No statistically significant difference was found in the pharmacokinetic and pharmacodynamic parameters tested in paired plasma and effluent samples with Wilcoxon test. Conclusion Spent effluent of continuous renal replacement therapy could be used for therapeutic drug monitoring of imipenem instead of blood sampling in critically ill patients.
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Han SS, Bae E, Song SH, Kim DK, Kim YS, Han JS, Joo KW. NT-proBNP Is Predictive of the Weaning from Continuous Renal Replacement Therapy. TOHOKU J EXP MED 2016; 239:1-8. [DOI: 10.1620/tjem.239.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Eunjin Bae
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
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Liu S, Cheng QL, Zhang XY, Ma Q, Liu YL, Pan R, Cai XY. Application of continuous renal replacement therapy for acute kidney injury in elderly patients. Int J Clin Exp Med 2015. [PMID: 26309685 DOI: 10.1002/14651858.cd005127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aims to analyze the factors that affect the prognosis of continuous renal replacement therapy (CRRT) in elderly patients with acute kidney injury (AKI). Data obtained from 41 elderly patients with AKI who underwent CRRT in our department between January 2001 and December 2010 was retrospectively evaluated in this study. The enrolled patients were 80 to 100 years old, with a mortality of 60.98%. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 27.8±5.6 points, and the mean risk coefficient was 0.80±0.10. The APACHE II score of the survival group was significantly higher than that of the death group. The comparisons of therapeutic dosages between <25 mL/(kg⋅h) and 25-50 mL/(kg⋅h), and between 25-50 mL/(kg⋅h) and >50 mL/(kg⋅h) all had no statistical significance. The prognosis of CRRT and the number of involved organs were related to the APACHE II score. Logistic regression analysis revealed that the number of involved organ, APACHE II score, mechanical ventilation, and hypoalbuminemia were the major risk coefficients that affected the prognosis of patients with bedside hemofiltration. The turnover of elderly CRRT patients was related to the number of involved organs, APACHE II score, mechanical ventilation, hypoalbuminemia, and other factors. The APACHE II score was the important reference index of CRRT starting time and could predict mortality risk.
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Affiliation(s)
- Sheng Liu
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Qing-Li Cheng
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Xiao-Ying Zhang
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Qiang Ma
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Yu-Ling Liu
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Rong Pan
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Xiao-Yan Cai
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
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Liu S, Cheng QL, Zhang XY, Ma Q, Liu YL, Pan R, Cai XY. Application of continuous renal replacement therapy for acute kidney injury in elderly patients. Int J Clin Exp Med 2015; 8:9973-8. [PMID: 26309685 PMCID: PMC4537993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/28/2015] [Indexed: 05/19/2024]
Abstract
This study aims to analyze the factors that affect the prognosis of continuous renal replacement therapy (CRRT) in elderly patients with acute kidney injury (AKI). Data obtained from 41 elderly patients with AKI who underwent CRRT in our department between January 2001 and December 2010 was retrospectively evaluated in this study. The enrolled patients were 80 to 100 years old, with a mortality of 60.98%. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 27.8±5.6 points, and the mean risk coefficient was 0.80±0.10. The APACHE II score of the survival group was significantly higher than that of the death group. The comparisons of therapeutic dosages between <25 mL/(kg⋅h) and 25-50 mL/(kg⋅h), and between 25-50 mL/(kg⋅h) and >50 mL/(kg⋅h) all had no statistical significance. The prognosis of CRRT and the number of involved organs were related to the APACHE II score. Logistic regression analysis revealed that the number of involved organ, APACHE II score, mechanical ventilation, and hypoalbuminemia were the major risk coefficients that affected the prognosis of patients with bedside hemofiltration. The turnover of elderly CRRT patients was related to the number of involved organs, APACHE II score, mechanical ventilation, hypoalbuminemia, and other factors. The APACHE II score was the important reference index of CRRT starting time and could predict mortality risk.
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Affiliation(s)
- Sheng Liu
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Qing-Li Cheng
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Xiao-Ying Zhang
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Qiang Ma
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Yu-Ling Liu
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Rong Pan
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
| | - Xiao-Yan Cai
- Department of Geriatric Nephrology, Chinese PLA General Hospital Beijing 100853, China
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Gheorghiu G, Benteu D, Neamţu C, Boieru R, Ţăranu G, Săndesc D. Benefits of early haemofiltration during aorto-bifemural bypass with mesenteric revascularization - a case report. Rom J Anaesth Intensive Care 2015; 22:55-58. [PMID: 28913457 PMCID: PMC5505335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
The intraoperative vs postoperative initiation of haemofiltration procedures in patients submitted for major vascular surgery is a controversial issue and a subject of debate in recent literature. We report the case of a 50 yr old patient scheduled for aorto-bifemoral bypass with mesenteric revascularization in whom the haemofiltration procedure (Prismaflex with Onix filter) was installed intraoperatively. Known to have non-insulin-dependent type 2 diabetes, the patient was admitted for Leriche syndrome, abdominal aorta thrombosis, superior and inferior mesenteric artery occlusion, celiac trunk occlusion, bilateral critical limb ischemia and mild renal impairment. The filtration rate was 25 ml/kg/h, ultrafiltration rate of 50 ml/h and 2 h clampation time. Haemofiltration was continued postoperatively in the ICU for another 48 h. The patient had a favorable evolution with restoration of renal function and a significant improvement of the biochemical parameters. In conclusion the early haemofiltration applied in this case provided clear beneficial effects, probably preventing the evolution towards multiple organ dysfunction syndrome.
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Affiliation(s)
- Gabriel Gheorghiu
- „Victor Babes” University of Medicine and Pharmacy Timisoara, X Department, Intensive Care Department, Romania
| | - Diana Benteu
- Emergency County Hospital Timisoara, Intensive Care Department, Romania
| | - Claudiu Neamţu
- Emergency County Hospital Timisoara, Intensive Care Department, Romania
| | - Raluca Boieru
- Emergency County Hospital Timisoara, Vascular Surgery Department, Romania
| | - Georgel Ţăranu
- Emergency County Hospital Timisoara, Vascular Surgery Department, Romania
| | - Dorel Săndesc
- „Victor Babes” University of Medicine and Pharmacy Timisoara, X Department, Intensive Care Department, Romania
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Jones SL, Devonald MAJ. How acute kidney injury is investigated and managed in UK intensive care units--a survey of current practice. Nephrol Dial Transplant 2013; 28:1186-1190. [DOI: 10.1093/ndt/gft015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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