Advances in chronic kidney disease
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Adv Chronic Kidney Dis · May 2016
ReviewFluid as a Drug: Balancing Resuscitation and Fluid Overload in the Intensive Care Setting.
Intravenous fluid resuscitation is ubiquitous throughout medicine and is often considered a benign procedure. Yet, there is now clear recognition of the potential harms of fluid overload after initial resuscitation. ⋯ In addition, evidence has emerged to suggest that outcomes may be different between resuscitation with chloride-rich vs balanced crystalloid solutions. In this article, we review the current literature regarding choice of intravenous fluids for resuscitation in the intensive care setting and describe the dangers associated with fluid overload in critically ill patients.
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Prolonged intermittent renal replacement therapy (PIRRT) is becoming an increasingly popular alternative to continuous renal replacement therapy in critically ill patients with acute kidney injury. There are significant practice variations in the provision of PIRRT across institutions, with respect to prescription, technology, and delivery of therapy. ⋯ However, due to lack of standardization of the procedure, PIRRT still poses significant challenges, especially pertaining to appropriate drug dosing. Future guidelines and clinical trials should work toward developing consensus definitions for PIRRT and ensure optimal delivery of therapy.
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Adv Chronic Kidney Dis · May 2016
ReviewExtracorporeal Membrane Oxygenation-What the Nephrologist Needs to Know.
Extracorporeal membrane oxygenation (ECMO) use in adults is rapidly increasing in its use for both cardiac and respiratory failure. ECMO exists in 2 primary configurations: veno-venous ECMO, used in the setting of isolated respiratory failure, and veno-arterial ECMO, which can be used in respiratory failure but is mandatory in the setting of cardiac failure. ⋯ No consensus exists regarding the optimal technique, but the use of continuous renal replacement machines has been shown to be safe and effective in patients on ECMO. An understanding of the basic principles and functionality of ECMO is important for both acid-base and fluid management in the intensive care unit.
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Adv Chronic Kidney Dis · May 2016
ReviewImmediate Consequences of Acute Kidney Injury: The Impact of Traditional and Nontraditional Complications on Mortality in Acute Kidney Injury.
Acute kidney injury (AKI) that requires renal replacement therapy is associated with a mortality rate that exceeds 50% in the intensive care unit, which is greater than other serious illnesses such as acute lung injury and myocardial infarction. Much information is now available regarding the complications of AKI that contribute to mortality and may be usefully categorized as "traditional" and "nontraditional". ⋯ In this review, we discuss both traditional and nontraditional complications of AKI with a focus on factors that contribute to mortality, considering both pathophysiology and potential remedies. Because AKI is the most common inpatient consult to nephrologists, it is essential to be aware of the complications of AKI that contribute to mortality to devise appropriate treatment strategies to prevent and manage AKI complications with the ultimate goal of reducing the unacceptably high mortality rate of AKI.