Advances in chronic kidney disease
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Acute kidney injury (AKI) is a frequent and significant complication of cancer and cancer therapy. Cancer patients frequently encounter risk factors for AKI including older age, CKD, prerenal conditions, sepsis, exposure to nephrotoxins, and obstructive physiology. ⋯ This complication can have significant consequences, including effects on patients' ability to continue to receive therapy for their malignancy. This review will serve to summarize potential etiologies of AKI that present in patients with cancer as well as to highlight specific patient populations, such as the critically ill cancer patient.
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Adv Chronic Kidney Dis · Jan 2014
ReviewThe kidney effects of hematopoietic stem cell transplantation.
Hematopoietic stem cell transplant (HSCT) patients are at risk for acute kidney disease and CKD, which confer excess morbidity and mortality in this patient population. A main cause of acute kidney injury (AKI) in stem cell recipients is prerenal azotemia, but acute tubular necrosis (ATN), obstruction, marrow transfusion toxicity, and hepatic sinusoidal obstruction syndrome also contribute. ⋯ For most patients, the exact etiology of CKD is never identified, but graft vs host disease and thrombotic microangiopathy are important diagnoses to consider. Stem cell transplant patient survival on dialysis is generally poor, but kidney transplantation is a safe and reasonable option for HSCT recipients who progress to ESRD.
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Adv Chronic Kidney Dis · Jul 2013
ReviewEducation for patients with progressive CKD and acute-start dialysis.
For individuals living with CKD and those who have been discovered to have ESRD, the decisions facing them can be daunting. Such decisions include having renal replacement therapy (RRT) or conservative care, having a kidney transplant, or selecting a modality of dialysis that would fit their lifestyle and values. ⋯ We also present an approach to educate and support those who have urgently started dialysis and require chronic RRT. This educational model has its basis in theories of education and decision-making and has been used with success in this population.