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Pardo M, Spencer E, Odunayo A, Ramirez ML, Rudloff E, Shafford H, Weil A, Wolff E. 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2024; 60:131-163. [PMID: 38885492 DOI: 10.5326/jaaha-ms-7444] [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: 06/20/2024]
Abstract
Fluids are drugs used in veterinary patients capable of producing beneficial therapeutic or inadvertent harmful effects within the body's intravascular, interstitial, and intracellular fluid spaces. The individualized design of a fluid therapy plan requires careful patient assessment and targeted selection of proper fluid types, administration routes, and rates, along with adjustments during therapy tailored specifically as per the individual patient's fluid requirement and therapeutic response. Personalized fluid prescriptions and vigilant patient monitoring help avoid patient morbidity from body fluid deficiencies, fluid excess, and electrolyte derangements and support better patient outcomes. These guidelines provide an overview of fluid dynamics within the fluid spaces of the body, describe various types of fluids and their uses, and outline recommendations for fluid administration for resuscitation, rehydration, and maintenance purposes. The guidelines also outline approaches to fluid therapy for anesthetized patients and reiterate the recommendations of reduced fluid rates in this population of patients. Additionally, the guidelines include practical fluid therapy strategies for patients with various common disorders. The goal of these guidelines is to help veterinary professionals safely and effectively prescribe and administer fluid therapy for canine and feline patients.
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Affiliation(s)
- Mariana Pardo
- Critical Care Veterinarian Consulting, Pleasantville, New York (M.P.)
| | - Erin Spencer
- Veterinary Emergency Group, Derry, New Hampshire (E.S.)
| | | | - Mary L Ramirez
- North Dallas Veterinary Emergency and Specialty Hospital, Frisco, Texas (M.L.R.)
| | - Elke Rudloff
- Blue Pearl Pet Hospice, Milwaukee, Wisconsin (E.R.)
| | - Heidi Shafford
- Veterinary Anesthesia Specialists, Gladstone, Oregon (H.S.)
| | - Ann Weil
- Purdue University, West Lafayette, Indiana (A.W.)
| | - Ewan Wolff
- Blue Pearl NE Portland, Portland, Oregon (E.W.)
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Eslami V, Mousavi S, Irilouzadian R, Baghsheikhi H, Fesharaki MJ, Samavat S. Pericardial effusion in patients with chronic kidney disease: A two-center study. PLoS One 2024; 19:e0302200. [PMID: 38843270 PMCID: PMC11156368 DOI: 10.1371/journal.pone.0302200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/01/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND AND AIMS Pericardial effusion (PE) is a prevalent form of pericardial involvement in chronic kidney disease (CKD). This study aims to investigate the clinical and laboratory features associated with PE severity in patients with CKD. METHODS In this cross-sectional study, we examined the medical records of patients admitted to tertiary hospitals with International Classification of Diseases 10th Revision (ICD-10) codes associated with CKD and PE. We included 112 CKD patients in stage 4 and 5 non-dialysis (ND) with PE for assessing the clinical and laboratory features of severity. RESULTS Patients were divided into two categories based on the severity of PE. Seventy-two patients had mild and 40 had moderate and severe PE. Univariate analysis of demographic and laboratory features on the date of admission demonstrated that chest pain, dyspnea, serum albumin, and neutrophil-to-lymphocyte ratio (NLR) are associated with the severity of PE. The univariate analysis on the date of echocardiography showed significantly higher white blood cell count (WBC), neutrophil count (percentage and absolute count), and NLR, along with significantly lower lymphocyte percentage and serum albumin among patients with moderate and severe PE. In the multivariable analysis of laboratory features, on admission hypoalbuminemia (p-value = 0.014, OR = 4.03, CI: 1.32-12.25) and NLR greater than 5.5 (p-value = 0.015, OR = 4.22, CI: 1.32-13.50) were significantly associated with moderate and severe PE. In a parallel matter, at the time of echocardiography hypoalbuminemia (p-value = 0.004, OR = 5.38, CI: 1.74-16.65) and neutrophilia (p-value = 0.005, OR = 7.94, CI: 1.89-33.44) were significantly associated with moderate and severe PE. CONCLUSION Despite advancements in the diagnosis and treatment of CKD, PE is still a concerning issue in these patients. This study revealed that hypoalbuminemia, neutrophilia, and NLR greater than 5.5 could be predictive factors of moderate and severe PE in CKD patients with PE. Further prospective study with larger sample size is needed to confirm these results.
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Affiliation(s)
- Vahid Eslami
- Cardiovascular Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - SeyedehFatemeh Mousavi
- Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rana Irilouzadian
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hediyeh Baghsheikhi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Jafari Fesharaki
- Department of Cardiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Samavat
- Chronic Kidney Disease Research Center (CKDRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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Tang J, Wu C, Zhong Z. Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs. Neurol Ther 2024; 13:749-761. [PMID: 38635141 PMCID: PMC11136917 DOI: 10.1007/s40120-024-00612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission. METHODS Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. RESULTS A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively). CONCLUSION Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.
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Affiliation(s)
- Jia Tang
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Changdong Wu
- Xinjiang Emergency Center, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tian-Chi Road, Tianshan District, Urumqi, 830001, Xinjiang, China.
| | - Zhenguang Zhong
- Department of Bioengineering, Imperial College London, London, UK
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Griva P, Talliou C, Rougeris L, Samara D, Panagouli K, Varvarousi G, Papa M, Kathopoulis N, Chantziara V, Rovina N. Restoration of Pulmonary Compliance after Laparoscopic Gynecologic Surgery Using a Recruitment Maneuver. J Pers Med 2024; 14:451. [PMID: 38793032 PMCID: PMC11122417 DOI: 10.3390/jpm14050451] [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: 03/13/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. METHODS A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). RESULTS Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH2O, IQR: 9.75 mL/cmH2O), high Body Mass Index 30.32 kg/m2 (IQR: 1.05 kg/m2), and high initial plateau airway pressure (16.5 cmH2O, IQR: 0.75 cmH2O). CONCLUSIONS Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.
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Affiliation(s)
- Panagiota Griva
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Christina Talliou
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Loizos Rougeris
- Department of Anaesthesiology, Rea Maternity Hospital, 17564 Athens, Greece
| | - Dimitra Samara
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Giolanda Varvarousi
- Department of Anaesthesiology, General Hospital of Athens Alexandra, 11528 Athens, Greece
| | - Maria Papa
- Department of Anaesthesiology, General Hospital of Athens Alexandra, 11528 Athens, Greece
| | - Nikolaos Kathopoulis
- Department of Obstetrics and Gynaecology, General Hospital of Athens Alexandra, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasiliki Chantziara
- 1st Department of Respiratory Medicine, Sotiria Thoracic Diseases Hospital of Athens, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, Sotiria Thoracic Diseases Hospital of Athens, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Ioannou ADF, Tai C, Labato MA, Butty EM. Retrospective evaluation of 22 dogs with leptospirosis treated with extracorporeal renal replacement therapies (2018-2021). J Vet Intern Med 2024; 38:1051-1059. [PMID: 38334229 PMCID: PMC10937474 DOI: 10.1111/jvim.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Outcomes of dogs with acute kidney injury secondary to leptospirosis (AKI-L) treated using renal replacement therapies (RRT) are poorly characterized. HYPOTHESIS/OBJECTIVES Describe survival to discharge, short (≤30 days) and long-term (≥6 months) outcomes of AKI-L dogs receiving RRT and determine if there is a significant difference in maximum blood urea nitrogen (maxBUN), maximum creatinine (maxCr), maximum bilirubin (maxBili) and the number of body systems affected between survivors and non-survivors. ANIMALS Twenty-two client-owned dogs with AKI-L receiving RRT. METHODS Retrospective medical record review of dogs with AKI-L that received RRT between 2018 and 2021. RESULTS Sixteen of 22 (73%) dogs survived to discharge. Of the survivors, 13 (81%) were alive >30 days from discharge and 12 (75%) were alive at 6 months from discharge. Factors significantly higher in non-survivors included number of body systems affected (survivors: 1 (19%), 2 (50%), 3 (25%) and 4 (6%) vs non-survivors: 3 (33.3%), and 4 (66.7%); P = .01) and median maxBili (survivors: 1.9 mg/dL; range, 0.1-41.6 vs non-survivors: 21.0 mg/dL; range, 12.3-38.9; P = .02). There was no significant difference in median maxBUN (survivors: 153.0 mg/dL; range, 67-257 vs non-survivors: 185.5 mg/dL; range, 102-218; P = .44) and median maxCr (survivors: 9.8 mg/dL; range, 6.2-15.9 vs non-survivors: 9.8 mg/dL; range, 8.4-13.5; P = .69) between survivors and non-survivors. CONCLUSIONS AND CLINICAL IMPORTANCE Regardless of azotemia severity, dogs with AKI-L receiving RRT have a good survival rate to discharge. The number of body systems affected and hyperbilirubinemia might be associated with worse outcomes.
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Affiliation(s)
- Antonia Da Fonseca Ioannou
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Carolyn Tai
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Mary Anna Labato
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Emmanuelle M. Butty
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
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Nikitiuk BE, Rydzewska-Rosołowska A, Kakareko K, Głowińska I, Hryszko T. On Whether Ca-125 Is the Answer for Diagnosing Overhydration, Particularly in End-Stage Kidney Disease Patients-A Systematic Review. Int J Mol Sci 2024; 25:2192. [PMID: 38396869 PMCID: PMC10889175 DOI: 10.3390/ijms25042192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Overhydration (OH) is a prevalent medical problem that occurs in patients with kidney failure, but a specific marker has still not been found. Patients requiring kidney replacement therapy suffer from a water imbalance, which is correlated with mortality rates in this population. Currently, clinicians employ techniques such as bioimpedance spectroscopy (BIS) and ultrasound (USG) markers of overhydration or markers of heart and kidney function, namely NT-pro-BNP, GFR, or creatinine levels. New serum markers, including but not limited to Ca-125, galectin-3 (Gal-3), adrenomedullin (AMD), and urocortin-2 (UCN-2), are presently under research and have displayed promising results. Ca-125, which is a protein mainly used in ovarian cancer diagnoses, holds great potential to become an OH marker. It is currently being investigated by cardiologists as it corresponds to the volume status in heart failure (HF) and ventricular hypertrophy, which are also associated with OH. The need to ascertain a more precise marker of overhydration is urgent mainly because physical examinations are exceptionally inaccurate. The signs and symptoms of overhydration, such as edema or a gradual increase in body mass, are not always present, notably in patients with chronic kidney disease. Metabolic disruptions and cachexia can give a false picture of the hydration status. This review paper summarizes the existing knowledge on the assessment of a patient's hydration status, focusing specifically on kidney diseases and the role of Ca-125.
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Affiliation(s)
| | - Alicja Rydzewska-Rosołowska
- 2nd Department of Nephrology, Hypertension, and Internal Medicine with Dialysis Unit, Medical University of Bialystok, 15-276 Bialystok, Poland; (B.E.N.); (K.K.); (I.G.); (T.H.)
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Lambert TP, Chan M, Sanchez-Perez JA, Nikbakht M, Lin DJ, Nawar A, Bashar SK, Kimball JP, Zia JS, Gazi AH, Cestero GI, Corporan D, Padala M, Hahn JO, Inan OT. A Comparison of Normalization Techniques for Individual Baseline-Free Estimation of Absolute Hypovolemic Status Using a Porcine Model. BIOSENSORS 2024; 14:61. [PMID: 38391980 PMCID: PMC10886994 DOI: 10.3390/bios14020061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Hypovolemic shock is one of the leading causes of death in the military. The current methods of assessing hypovolemia in field settings rely on a clinician assessment of vital signs, which is an unreliable assessment of hypovolemia severity. These methods often detect hypovolemia when interventional methods are ineffective. Therefore, there is a need to develop real-time sensing methods for the early detection of hypovolemia. Previously, our group developed a random-forest model that successfully estimated absolute blood-volume status (ABVS) from noninvasive wearable sensor data for a porcine model (n = 6). However, this model required normalizing ABVS data using individual baseline data, which may not be present in crisis situations where a wearable sensor might be placed on a patient by the attending clinician. We address this barrier by examining seven individual baseline-free normalization techniques. Using a feature-specific global mean from the ABVS and an external dataset for normalization demonstrated similar performance metrics compared to no normalization (normalization: R2 = 0.82 ± 0.025|0.80 ± 0.032, AUC = 0.86 ± 5.5 × 10-3|0.86 ± 0.013, RMSE = 28.30 ± 0.63%|27.68 ± 0.80%; no normalization: R2 = 0.81 ± 0.045, AUC = 0.86 ± 8.9 × 10-3, RMSE = 28.89 ± 0.84%). This demonstrates that normalization may not be required and develops a foundation for individual baseline-free ABVS prediction.
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Affiliation(s)
- Tamara P. Lambert
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (M.C.); (O.T.I.)
| | - Michael Chan
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (M.C.); (O.T.I.)
| | - Jesus Antonio Sanchez-Perez
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
| | - Mohammad Nikbakht
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
| | - David J. Lin
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
| | - Afra Nawar
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
| | - Syed Khairul Bashar
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
| | - Jacob P. Kimball
- The Donald P. Shiley School of Engineering, University of Portland, Portland, OR 97203, USA;
| | - Jonathan S. Zia
- Division of Neurology & Neurological Sciences, Stanford School of Medicine, Palo Alto, CA 94304, USA;
| | - Asim H. Gazi
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA;
| | - Gabriela I. Cestero
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
| | - Daniella Corporan
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA 30308, USA; (D.C.); (M.P.)
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Muralidhar Padala
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA 30308, USA; (D.C.); (M.P.)
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA;
| | - Omer T. Inan
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (M.C.); (O.T.I.)
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (J.A.S.-P.); (M.N.); (D.J.L.); (A.N.); (S.K.B.); (G.I.C.)
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Cakir MU, Yavuz-Aksu B, Aksu U. Hypervolemia suppresses dilutional anaemic injury in a rat model of haemodilution. J Transl Int Med 2023; 11:393-400. [PMID: 38130643 PMCID: PMC10732576 DOI: 10.2478/jtim-2022-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives Haemodilution leads to complications in clinical practice. It is exactly unknown whether this damage is caused by the fluid or by the stretching of the vascular bed. We aimed to compare two different haemodilution techniques at the same anaemic level. Methods Normovolemic or hypervolemic haemodilution was performed on twelve adult male Wistar rats. In the normovolemic procedure, blood was withdrawn and instantaneously administered with similar amounts of 6% hydroxyethyl starch (HES 130/0.4). Fluid was administered without withdrawing blood in the hypervolemic procedure. In both models, a 25% haematocrit level was targeted and kept at this level for 90 min to deepen the anaemia effect. Besides haemodynamics measurement, renal function (creatinine, blood urea nitrogen) and injury (tissue norepinephrine, malondialdehyde) were evaluated. Also, systemic hypoxia (lactate), oxidative stress (malondialdehyde, ischaemia-modified albumin), inflammation (tumour necrosis factor-alpha [TNF-α]), osmotic stress, adrenal stress (norepinephrine, epinephrine), and vascular stretching (atrial natriuretic peptide [ANP]) were assessed. Results Arterial pressure in the normovolemic group was lower than in the hypervolemic group. Serum creatinine, blood urea nitrogen, and lactate levels were higher in the normovolemic group. Tissue norepinephrine and malondialdehyde levels were higher in the normovolemic group. Serum ANP, malondialdehyde, ischaemia-modified albumin, free haemoglobin, syndecan-1, and TNF-α were higher in both groups compared to respective baseline. Conclusions Normovolemic haemodilution may lead to hypoxic kidney injury. The hypervolemic state may be advantageous if fluid is to be administered. Thus, the effect of the fluid itself can be relatively masked.
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Affiliation(s)
- Muzaffer Utku Cakir
- Department of Biology, Faculty of Science, University of Istanbul, Istanbul34134, Turkey
| | - Berna Yavuz-Aksu
- Duzen Laboratory Group, Biochemistry Section, Istanbul34394, Turkey
| | - Ugur Aksu
- Department of Biology, Faculty of Science, University of Istanbul, Istanbul34134, Turkey
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Wilkinson SL. Urine Output Monitoring and Acute Kidney Injury in Non-mammalian Exotic Animal Critical Care. Vet Clin North Am Exot Anim Pract 2023; 26:673-710. [PMID: 37516459 DOI: 10.1016/j.cvex.2023.05.008] [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: 07/31/2023]
Abstract
Acute kidney injury (AKI) is a sudden, severe decrease in kidney function which can occur in any species. There are various causes of AKI, some of which are seen in domestic species and some that are unique to birds, reptiles, and amphibians. These species present unique challenges with AKI management, such as differences in anatomy and physiology, intravenous and urinary catheterization, repeated blood sampling, and their tendency to present in advanced states of illness. This article will discuss AKI, diagnosis, treatment, and prognosis for non-mammalian exotic species.
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Affiliation(s)
- Stacey Leonatti Wilkinson
- Avian and Exotic Animal Hospital of Georgia, 118 Pipemakers Circle Suite 110, Pooler, GA 31322, USA.
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Aikawa G, Ouchi A, Sakuramoto H, Hoshino T, Enomoto Y, Shimojo N, Inoue Y. Association of early-onset constipation and diarrhoea with patient outcomes in critically ill ventilated patients: A retrospective observational cohort study. Aust Crit Care 2023; 36:737-742. [PMID: 36400625 DOI: 10.1016/j.aucc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Constipation and diarrhoea are closely related, but few studies have examined them simultaneously. OBJECTIVES The purpose of this study was to describe patient defecation status after intensive care unit (ICU) admission and determine the association between early-onset constipation and diarrhoea following ICU admission with outcomes for critically ill ventilated patients. METHODS Patients ventilated for ≥48 h in an ICU were retrospectively investigated, and their defecation status was assessed during the first week after admission. Early-onset constipation and diarrhoea were defined as onset during the first week of ICU admission. The patients were divided into three groups-normal defecation, constipation, and diarrhoea-and multiple comparisons were performed using the Kruskal-Wallis test and the Mann-Whitney U test with Bonferroni adjustment. Additionally, multivariable analysis was performed for mortality and length of stay using the linear and logistic regression models. RESULTS Of the 85 critically ill ventilated patients, 47 (55%) experienced early-onset constipation and 12 (14%) experienced early-onset diarrhoea. Patients with normal defecation and diarrhoea increased from the 4th and 5th day of ICU admission. Early-onset diarrhoea was significantly associated with the length of ICU stay (B = 7.534, 95% confidence interval: 0.116-14.951). CONCLUSIONS Early-onset constipation and diarrhoea were common in critically ill ventilated patients, and early-onset diarrhoea was associated with the length of ICU stay.
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Affiliation(s)
- Gen Aikawa
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan; Intensive Care Unit, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, 1-1 Asty, Munakata, Fukuoka, Japan
| | - Tetsuya Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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11
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Turner P. Implementation of the medical emergencies in eating disorders in adults guidance on non-specialist units. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S8-S12. [PMID: 37410686 DOI: 10.12968/bjon.2023.32.13.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The Royal College of Psychiatrists recently published data showing an 84% increase in UK hospital admissions for eating disorders over the past 5 years, highlighting the importance of the college's new Medical Emergencies in Eating Disorders (MEED) guidance. This includes a 79% increase among adults, many of whom are admitted to general medical wards that do not have input from expert eating disorder services. Consequently, the multidisciplinary nutrition support team, nutrition specialist nurses and dietitians have a potentially vital role in implementing MEED to ensure that the appropriate nutritional, fluid and electrolyte management is in place for safe refeeding and avoidance of the potentially harmful underfeeding syndrome. Furthermore, the guidance includes special recommendations for the use of nasogastric feeding in eating disorder patients, which requires input from experts in this field, including specialist nurses and dietitians. This article focuses on the implementation of MEED on hospital wards that do not have input from specialist eating disorders services.
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Affiliation(s)
- Pete Turner
- Clinical Specialist Dietitian, Department of Nutrition Diet Therapy, Ulster Hospital, Dundonald, Northern Ireland
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12
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Brown RB. Salt-Sensitive Hypertension: Mediation by Salt-Induced Hypervolemia and Phosphate-Induced Vascular Calcification. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2023; 17:11795468231158206. [PMID: 37434790 PMCID: PMC10331233 DOI: 10.1177/11795468231158206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 07/13/2023]
Abstract
Preventing hypertension by restricting dietary salt intake, sodium chloride, is well established in public health policy, but a pathophysiological mechanism has yet to explain the controversial clinical finding that some individuals have a greater risk of hypertension from exposure to salt intake, termed salt-sensitive hypertension. The present perspective paper synthesizes interdisciplinary findings from the research literature and offers novel insights proposing that the pathogenesis of salt-sensitive hypertension is mediated by interaction of salt-induced hypervolemia and phosphate-induced vascular calcification. Arterial stiffness and blood pressure increase as calcification in the vascular media layer reduces arterial elasticity, preventing arteries from expanding to accommodate extracellular fluid overload in hypervolemia related to salt intake. Furthermore, phosphate has been found to be a direct inducer of vascular calcification. Reduction of dietary phosphate may help reduce salt-sensitive hypertension by lowering the prevalence and progression of vascular calcification. Further research should investigate the correlation of vascular calcification with salt-sensitive hypertension, and public health recommendations to prevent hypertension should encourage reductions of both sodium-induced hypervolemia and phosphate-induced vascular calcification.
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Affiliation(s)
- Ronald B Brown
- Ronald B Brown, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
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13
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Parkinson L. Fluid Therapy in Exotic Animal Emergency and Critical Care. Vet Clin North Am Exot Anim Pract 2023:S1094-9194(23)00022-1. [PMID: 37308371 DOI: 10.1016/j.cvex.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many new concepts are emerging in the understanding of fluid therapy in human and mammalian medicine, including the role of the glycocalyx, increased understanding of fluid, sodium, and chloride overload, and the advantages of colloid administration in the form of albumin. None of these concepts, however, appear to be directly applicable to non-mammalian exotic patients, and careful consideration of their alternate physiology is required when formulating fluid plans for these patients.
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Affiliation(s)
- Lily Parkinson
- Brookfield Zoo, Chicago Zoological Society, 3300 Golf Road, Brookfield, IL 60513, USA.
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14
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Wilkinson SL. Urine Output Monitoring and Acute Kidney Injury in Mammalian Exotic Animal Critical Care. Vet Clin North Am Exot Anim Pract 2023:S1094-9194(23)00023-3. [PMID: 37302935 DOI: 10.1016/j.cvex.2023.05.005] [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: 06/13/2023]
Abstract
Acute kidney injury (AKI) is a sudden, severe decrease in kidney function which can occur in any species. There are various causes of AKI, some of which are seen in domestic species and some that are unique to exotics. Exotic animals present unique challenges with AKI management such as differences in anatomy and physiology, intravenous and urinary catheterization, repeated blood sampling, and their tendency to present in advanced states of illness. This article will discuss AKI, diagnosis, treatment, and prognosis for exotic companion mammals. The following article will discuss the same in non-mammalian patients.
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Affiliation(s)
- Stacey Leonatti Wilkinson
- Avian and Exotic Animal Hospital of Georgia, 118 Pipemakers Circle Suite 110, Pooler, GA 31322, USA.
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15
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Lin CK, Tsai YH, Kao KC, Lin CM, Zhou SK, Ho MC, Huang SY, Fang YH, Chang CC, Lee WC, Lee YL, Chen MC, Hsieh MJ, Lin YC, Hung MS, Kuo WC, Lin BS. Serum vascular endothelial growth factor affects tissue fluid accumulation and is associated with deteriorating tissue perfusion and oxygenation in severe sepsis: a prospective observational study. Eur J Med Res 2023; 28:155. [PMID: 37085944 PMCID: PMC10120235 DOI: 10.1186/s40001-023-01119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/11/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Positive fluid balance and tissue fluid accumulation are associated with adverse outcomes in sepsis. Vascular endothelial growth factor (VEGF) increases in sepsis, promotes vascular permeability, and may affect tissue fluid accumulation and oxygenation. We used near-infrared spectroscopy (NIRS) to estimate tissue hemoglobin (Hb) oxygenation and water (H2O) levels to investigate their relationship with serum VEGF levels. MATERIAL AND METHODS New-onset severe sepsis patients admitted to the intensive care unit were enrolled. Relative tissue concentrations of oxy-Hb ([HbO2]), deoxy-Hb ([HbR]), total Hb ([HbT]), and H2O ([H2O]) were estimated by near-infrared spectroscopy (NIRS) for three consecutive days and serum VEGF levels were measured. Comparisons between oliguric and non-oliguric patients were conducted and the correlations between variables were analyzed. RESULTS Among 75 eligible patients, compared with non-oliguric patients, oliguric patients were administrated more intravascular fluids (median [IQR], 1926.00 [1348.50-3092.00] mL/day vs. 1069.00 [722.00-1486.75] mL/day, p < 0.001) and had more positive daily net intake and output (mean [SD], 1,235.06 [1303.14] mL/day vs. 313.17 [744.75] mL/day, p = 0.012), lower [HbO2] and [HbT] over the three-day measurement (analyzed by GEE p = 0.01 and 0.043, respectively) and significantly higher [H2O] on the third day than on the first two days (analyzed by GEE p = 0.034 and 0.018, respectively). Overall, serum VEGF levels were significantly negatively correlated with [HbO2] and [HbT] (rho = - 0.246 and - 0.266, p = 0.042 and 0.027, respectively) but positively correlated with [H2O] (rho = 0.449, p < 0.001). Subgroup analysis revealed a significant correlation between serum VEGF and [H2O] in oliguric patients (rho = 0.532, p = 0.003). Multiple regression analysis determined the independent effect of serum VEGF on [H2O] (standardized coefficient = 0.281, p = 0.038). CONCLUSIONS In severe sepsis, oliguria relates to higher positive fluid balance, lower tissue perfusion and oxygenation, and progressive tissue fluid accumulation. Elevated serum VEGF is associated with worsening tissue perfusion and oxygenation and independently affects tissue fluid accumulation.
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Affiliation(s)
- Chin-Kuo Lin
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
- Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan
| | - Ying-Huang Tsai
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Linkou, Taoyuan City, 333, Taiwan
| | - Kuo-Chin Kao
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Linkou, Taoyuan City, 333, Taiwan
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, 33302, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305, Taiwan
| | - Chieh-Mo Lin
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
- Chang Gung University of Science and Technology, No. 2, West Sec. Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan
| | - Shao-Kui Zhou
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, No. 301, Gaotie 3Rd Road, Guiren Dist., Tainan City, 71150, Taiwan
| | - Meng-Chin Ho
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
| | - Shu-Yi Huang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
- Chang Gung University of Science and Technology, No. 2, West Sec. Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan
| | - Yu-Hung Fang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
| | - Che-Chia Chang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
| | - Wei-Chun Lee
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
| | - Yueh-Lin Lee
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
| | - Min-Chi Chen
- Department of Public Health, Biostatistics Consulting Center, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Guishan, Taoyuan City, 33302, Taiwan
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd, Putzu City, Chiayi County, 61363, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Linkou, Taoyuan City, 333, Taiwan
| | - Yu-Ching Lin
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
- Department of Respiratory Care, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd, Putzu City, Chiayi County, 61363, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Ming-Szu Hung
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
- Department of Respiratory Care, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd, Putzu City, Chiayi County, 61363, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Wen-Chun Kuo
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, West Sec. Chiapu Rd., Putzu City, Chiayi County, 61363, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, No. 301, Gaotie 3Rd Road, Guiren Dist., Tainan City, 71150, Taiwan.
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16
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Suwabe T, Ubara Y, Oba Y, Mizuno H, Ikuma D, Yamanouchi M, Sekine A, Tanaka K, Hasegawa E, Hoshino J, Sawa N. Changes in Kidney and Liver Volumes in Patients With Autosomal Dominant Polycystic Kidney Disease Before and After Dialysis Initiation. Mayo Clin Proc Innov Qual Outcomes 2023; 7:69-80. [PMID: 36712823 PMCID: PMC9873948 DOI: 10.1016/j.mayocpiqo.2022.12.005] [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] [Indexed: 01/22/2023] Open
Abstract
Objective To examine the changes in total kidney volume (TKV) and total liver volume (TLV) before and after dialysis initiation in patients with autosomal dominant polycystic kidney disease. Patients and Methods This was a retrospective, single-center cohort study to investigate the changes in TKV and TLV before and after dialysis initiation, along with influencing factors, using linear mixed models. We enrolled 95 patients with autosomal dominant polycystic kidney disease (85 receiving hemodialysis [HD] and 10 receiving peritoneal dialysis [PD]) who began receiving dialysis at Toranomon Hospital from January 1, 2008, to December 31, 2020. Results The least squares mean TKV ratio (TKV at each time point/TKV at dialysis initiation) was 63.8% (95% confidence interval [CI], 54.7%-72.9%) at 6 years before dialysis initiation and 95.5% (95% CI, 82.9%-108.2%) at 6 years after dialysis initiation (P<.001). A multivariate linear mixed model analysis revealed that dialysis style (HD or PD) had the strongest effect on changes in TKV (P=.002). The least squares mean TLV ratio was 98.2% (95% CI, 88.4%-108.0%) at 6 years before dialysis initiation and 95.7% (95% CI, 85.2%-106.2%) at 6 years after dialysis initiation (P=.01). Although PD did not have significant effects on changes in TLV (P=.27), the changes in TLV were greater in patients on PD than in those on HD. Conclusion The TKV increased until dialysis initiation and generally decreased after dialysis initiation. The TLV continued to increase even after dialysis initiation, however, changes in the TLV significantly decreased after dialysis initiation. The increases in TKV and TLV were greater in patients on PD than in those on HD.
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Key Words
- ACDK, acquired cystic disease of the kidney
- ADPKD, autosomal dominant polycystic kidney disease
- ALB, albumin
- BMI, body mass index
- BP, blood pressure
- CI, confidence interval
- CT, computed tomography
- ESKD, end-stage kidney disease
- HD, hemodialysis
- HR, heart rate
- MRI, magnetic resonance imaging
- PD, peritoneal dialysis
- PKD, polycystic kidney disease
- PLD, polycystic liver disease
- TAE, transcatheter arterial embolization
- TKV, total kidney volume
- TLV, total liver volume
- UN, urea nitrogen
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,Correspondence: Address to Tatsuya Suwabe, MD, MSc, PhD, Department of Nephrology, Toranomon Hospital, Kajigaya, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa 213-0015, Japan.
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Kiho Tanaka
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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Causal Association between Whole-Body Water Mass and Sleep Apnea: A Mendelian Randomization Study. Ann Am Thorac Soc 2022; 19:1913-1919. [PMID: 35727232 DOI: 10.1513/annalsats.202112-1331oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Growing evidence has suggested that body water content plays a critical role in sleep apnea. However, the causal relationship has not been established. Objectives: This study aimed to investigate whether increased whole-body water mass is causally associated with a higher risk of sleep apnea using two-sample Mendelian randomization (MR) analysis. Methods: Body water mass (BWM)-associated genetic instruments were extracted from a genome-wide association study conducted by Neale Lab, which incorporates 331,315 individuals of European ancestry. Genetic variants for sleep apnea were derived from the FinnGen dataset. MR analysis was performed using inverse variance-weighted and weight median methods, respectively. MR-Egger regression and MR-Pleiotropy Residual Sum and Outlier tests were applied to evaluate the directional pleiotropy. In addition, we performed a multivariable MR analysis that includes body mass index, snoring, and waist-to-hip ratio as covariate exposures to address their confounding effects. To elucidate mechanisms of the association between BWM and sleep apnea, we further conducted MR analysis on common edematous diseases. Results: MR estimates showed that per standard deviation increase in BWM led to an increase in the risk of sleep apnea by 49% (odds ratio [OR], 1.490; 95% confidence interval [CI], 1.308-1.696; P = 1.75 × 10-9). The result after MR-Pleiotropy Residual Sum and Outlier correction further supports their causal association (OR, 1.414; 95% CI, 1.253-1.595; P = 1.76 × 10-8). In addition, the multivariable MR analysis indicates a significant causal association between a higher BWM and increased risk of sleep apnea (OR, 1.204; 95% CI, 1.031-1.377; P = 0.036). Genetic predisposition to a higher BWM was also causally related to increased risk of edematous diseases. Conclusions: Our results suggested that increased BWM is a potential risk factor for sleep apnea. Pathologic edema is a possible intermediate factor mediating this causal association.
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Tello LH, Pardo MA. Fluid and Electrolyte Therapy During Vomiting and Diarrhea. Vet Clin North Am Small Anim Pract 2022; 52:673-688. [DOI: 10.1016/j.cvsm.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Ross L. Acute Kidney Injury in Dogs and Cats. Vet Clin North Am Small Anim Pract 2022; 52:659-672. [DOI: 10.1016/j.cvsm.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tinsman AE, Bellis TJ. Hyperinsulinemia/euglycemia and intravenous lipid emulsion therapy for the management of severe amlodipine toxicosis in a cat. Clin Case Rep 2021; 9:e05175. [PMID: 34934496 PMCID: PMC8650752 DOI: 10.1002/ccr3.5175] [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: 04/27/2021] [Revised: 09/23/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
Calcium-channel blockers (CCBs) are widely used in people and animals. Overdose can result in cardiovascular collapse and death. Hyperinsulinemia/euglycemia therapy (HIET) and intralipid therapy (ILT) are reported treatment options in people. This is the first report describing HIET and ILT as treatments for amlodipine toxicosis in a cat.
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Affiliation(s)
| | - Tara J. Bellis
- Emergency & Critical CareGarden State Veterinary ServicesIselinNJUSA
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