Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Aug 2012
New metrics for assessing diagnostic potential of candidate biomarkers.
New tests should improve the diagnostic performance of available tests. The area under the receiver operator characteristic curve has been the "metric of choice" to quantify new biomarker performance. Two new metrics, the integrated discrimination improvement (IDI) and net reclassification improvement (NRI), have been rapidly adopted to quantify the added value of a biomarker to an existing test. ⋯ The IDI reflected those small changes. Of the new metrics, the IDI, reported separately for those with and without the events, best represents the value of a new test. The risk assessment plot identified differences in the models not apparent in any of the metrics.
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Clin J Am Soc Nephrol · Aug 2012
Multicenter StudyAssociation between peritransplant kidney injury biomarkers and 1-year allograft outcomes.
Current tools to predict outcomes after kidney transplantation are inadequate. The objective of this study was to determine the association of perioperative urine neutrophil gelatinase-associated lipocalin and IL-18 with poor 1-year allograft function (return to dialysis or estimated GFR<30 ml/min per 1.73 m(2)). ⋯ Perioperative urine neutrophil gelatinase-associated lipocalin and IL-18 are associated with poor 1-year allograft function, suggesting their potential for identifying patients for therapies that minimize the risk of additional injury.
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Clin J Am Soc Nephrol · Aug 2012
ReviewRenal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. ⋯ RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This review summarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific research-focused questions that need to be addressed to improve outcomes in this at-risk population.
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Fibroblast growth factor 23 plays an important role in regulating phosphate and vitamin D homeostasis. Elevated levels of fibroblast growth factor 23 are independently associated with mortality in patients with CKD and ESRD. Whether fibroblast growth factor 23 levels are elevated and associated with adverse outcomes in patients with AKI has not been studied. ⋯ Among patients with AKI, fibroblast growth factor 23 levels are elevated and associated with greater risk of death or need for renal replacement therapy.
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Clin J Am Soc Nephrol · Aug 2012
Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic.
Recent studies evaluated the prevalence of hyperkalemia and related risk factors in patients with CKD of various stages, but there is limited relevant information in predialysis patients. This study aimed to examine the prevalence and factors associated with hyperkalemia in the structured environment of a low-clearance clinic. ⋯ The prevalence of hyperkalemia in predialysis patients with CKD is high. Even at this range of renal function, low estimated GFR seems to be the most important factor associated with hyperkalemia among the wide range of demographic, clinical, and laboratory characteristics studied.