Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Aug 2010
Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes.
Urine IL-18 (uIL-18) has demonstrated moderate capacity to predict acute kidney injury (AKI) and adverse outcomes in defined settings. Its ability to predict AKI and provide prognostic information in broadly selected, critically ill adults remains unknown. ⋯ uIL-18 did not reliably predict AKI development, but did predict poor clinical outcomes in a broadly selected, critically ill adult population.
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Clin J Am Soc Nephrol · Jul 2010
Comparative StudyBack-calculating baseline creatinine with MDRD misclassifies acute kidney injury in the intensive care unit.
The purpose of this study was to assess the viability of back-calculation with the Modification of Diet in Renal Disease (MDRD) formula to determine baseline creatinine on the basis of acute kidney injury (AKI) metrics, RIFLE criteria, and Acute Kidney Injury Network (AKIN) criteria for the purpose of clinical trial outcomes or epidemiology. ⋯ A measured rather than estimated value should be used for baseline creatinine in trials or epidemiologic studies of AKI.
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Clin J Am Soc Nephrol · Jul 2010
Individualizing decision-making--resurrecting the doctor-patient relationship in the anemia debate.
Among patients with chronic kidney disease (CKD), erythropoiesis-stimulating agents (ESAs) are approved for avoiding transfusions, a risk that increases when hemoglobin (Hgb) falls to <10 g/dl. Transfusions increase sensitization, prolong the waiting time to and the likelihood of transplantation, and when transplantation is performed worsen graft survival. Accordingly, the risk of transfusion among those expecting transplantation is comparable to that of cardiovascular events. ⋯ Accordingly, while initiating and maintaining ESA therapy, monitoring BP at home twice daily is warranted. The clinical decision-making process in managing anemia should consider the risks of transfusion; kidney transplant potential; presence of cancer; and the risks of stroke, heart failure, and possibly death. Above all, clinical decision-making should incorporate patient preference.