Advances in chronic kidney disease
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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.
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Adv Chronic Kidney Dis · Jan 2016
ReviewConservative Care of the Elderly CKD Patient: A Practical Guide.
Palliative care is a branch of medicine dedicated to the relief of symptoms experienced during the course of illness. Renal palliative medicine or kidney supportive care is an evolving branch of nephrology, which incorporates the principles of palliative care into the care of CKD and ESRD (dialysis, transplant, and conservatively managed) patients. Conservative (non-dialytic) management is a legitimate option for frail, elderly CKD patients in whom dialysis may not lead to an improvement in quality or duration of life. ⋯ Symptoms appear to increase as the patient nears death, and this must be anticipated. Recommendations for management are discussed in the article. Hospice care should be offered to all patients who are expected to die within the next 6 months, and supportive care should be provided to all CKD patients managed conservatively or with dialysis.
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Adv Chronic Kidney Dis · Sep 2015
ReviewChronic Kidney Disease and Related Long-Term Complications After Liver Transplantation.
Liver transplantation is the standard of care for patients with decompensated cirrhosis. Liver transplantation recipients have excellent short-term and long-term outcomes including patient and graft survival. ⋯ Occurrence of Stage 4 chronic kidney disease and end stage renal disease substantially increases the risk of post-transplant deaths. Because majority of late post-transplant mortality is due to nonhepatic post-transplant comorbidities, personalized care directed toward risk factor modification may further improve post-transplant survival.