Clinical journal of the American Society of Nephrology : CJASN
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As the care of patients gets more focused and directed by predetermined standards of care, physicians must not lose sight of the primary focus of their treatment goal-maximizing the quality of life of each patient. Physicians must recognize the uniqueness of each individual's experience and make every effort to understand the domains that are of concern to each patient. In addition, physicians must make sure that this focus is not obscured by the setting of arbitrary standards and targets that lend themselves to easy assessments and reporting by simple laboratory measures or computer-generated data. Finally, physicians must focus on modifying and tailoring treatment to maximize each patient's health-related quality of life.
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Clin J Am Soc Nephrol · Jan 2015
AKI complications in critically ill patients: association with mortality rates and RRT.
AKI is associated with short- and long-term mortality. However, the exact contribution of AKI complications to the burden of mortality and whether RRT has any beneficial effect on reducing mortality rates in critically ill AKI patients are unknown. ⋯ A majority of the excess risk of mortality associated with AKI was attenuated by its fluid volume and metabolic complications, particularly in severe AKI. In addition, this study demonstrated that RRT is associated with a better outcome in patients with AKI-related complications.
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Clin J Am Soc Nephrol · Jan 2015
Randomized Controlled Trial Multicenter StudyFibroblast growth factor 23 and incident CKD in type 2 diabetes.
High levels of fibroblast growth factor 23 are associated with accelerated progression of CKD. Whether high fibroblast growth factor 23 levels also predict incident CKD is uncertain. ⋯ Higher fibroblast growth factor 23 levels are not independently associated with higher risk of incident CKD in patients with type 2 diabetes.
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Clin J Am Soc Nephrol · Jan 2015
Practice GuidelinePharmacokinetic assessment in patients receiving continuous RRT: perspectives from the Kidney Health Initiative.
The effect of AKI and modern continuous RRT (CRRT) methods on drug disposition (pharmacokinetics) and response has been poorly studied. Pharmaceutical manufacturers have little incentive to perform pharmacokinetic studies in patients undergoing CRRT because such studies are neither recommended in existing US Food and Drug Administration (FDA) guidance documents nor required for new drug approval. ⋯ The work group critically evaluated key considerations in the assessment of pharmacokinetics and drug dosing in CRRT, practical constraints related to conducting pharmacokinetic studies in critically ill patients, and the generalizability of observations made in the context of specific CRRT prescriptions and specific patient populations in order to identify efficient study designs capable of addressing the knowledge deficit without impeding drug development. Considerations for the standardized assessment of pharmacokinetics and development of corresponding drug dosing recommendations in critically ill patients with AKI receiving CRRT are proposed.