Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Mar 2013
Comparative StudyComparison analysis of nutritional scores for serial monitoring of nutritional status in hemodialysis patients.
This study aimed to compare the longitudinal performance of the malnutrition-inflammation score (MIS) and the geriatric nutritional risk index (GNRI), two nutritional scores for patients on maintenance hemodialysis. ⋯ Both MIS and GNRI are valid tools for longitudinal assessment of hemodialysis patients' nutritional status. MIS has lower interobserver reproducibility than GNRI; however, MIS is more comprehensive than GNRI.
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Clin J Am Soc Nephrol · Mar 2013
Multicenter StudyCombined association of creatinine, albuminuria, and cystatin C with all-cause mortality and cardiovascular and kidney outcomes.
Estimated GFR by serum creatinine (eGFRcreatinine) is a pivotal measure of kidney function in clinical practice but can be affected by several non-GFR determinants, resulting in misclassification. Combining multiple kidney markers to predict risk is an area of substantial interest. ⋯ eGFRcystatin can be a useful confirmatory marker in those with eGFRcreatinine <60 and whose ACR is <30 mg/g. This approach improves risk classification, and provides reassurance to a large group of individuals with eGFRcreatinine <60.
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Clin J Am Soc Nephrol · Mar 2013
Incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a comprehensive cancer center.
Incidence of AKI in hospitalized patients with cancer is increasing, but reports are scant. The objective of this study was to determine incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a cancer center. ⋯ The rate of AKI in patients admitted to a comprehensive cancer center was higher than the rate in most noncancer settings; was correlated significantly with diabetes, hyponatremia, intravenous contrast, chemotherapy, and antibiotics; and was associated with poorer clinical outcomes. AKI developed in many patients after admission. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.
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Clin J Am Soc Nephrol · Mar 2013
The risk of AKI in patients treated with intravenous solutions containing hydroxyethyl starch.
Intravenous fluids are arguably one of the most commonly administered inpatient therapies and for the most part have been viewed as part of the nephrologist's toolkit in the management of acute kidney disease. Recently, findings have suggested that intravenous fluids may be harmful if given in excess (quantitative toxicity) and that some may be more harmful than others (qualitative toxicity), particularly for patients who already have AKI. Recent clinical trials have investigated hydroxyethyl starch solutions and found worrying results for the renal community. In this brief review, we consider the published literature on the role of hydroxyethyl starch solutions in AKI, with particular emphasis on two large recent randomized clinical trials conducted in Europe and Australia.
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Biomarkers of AKI that can predict which patients will develop severe renal disease at the time of diagnosis will facilitate timely intervention in populations at risk of adverse outcomes. ⋯ Elevated uAnCR is associated with adverse outcomes in patients with AKI. These data are the first to demonstrate the utility of angiotensinogen as a prognostic biomarker of AKI after cardiac surgery.