Kidney international
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Kidney international · Dec 2009
Clinical TrialThe use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation.
A large percentage of patients on extracorporeal membrane oxygenation (ECMO) require continuous renal replacement therapy (CRRT) usually performed through a different venous access or by introducing a filter into the ECMO circuit. Here, we evaluated the efficacy and safety of including a CRRT machine in the circuit by connecting its inlet line after the centrifugal pump and its outlet line before the oxygenator. We tested the function of the combined system initially in a closed circuit, followed by an experimental animal study, and, finally, in a clinical trial with six children. ⋯ The mean life of the filters was about 138 h, and only one filter needed changing due to clotting. Our study shows that the introduction of a CRRT device into the ECMO circuit is a safe and effective technique that improves fluid balance, increases filter life, and does not cause complications. For these reasons, this may be a good method for performing CRRT in patients on ECMO.
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Kidney international · Dec 2009
Review Case Reports Comparative StudyAssessing acid-base disorders.
Effective management of acid-base disorders depends on accurate diagnosis. Three distinct approaches are currently used in assessing acid-base disorders: the physiological approach, the base-excess approach, and the physicochemical approach. ⋯ We then highlight the application of each approach to patient care. We conclude with a brief synthesis and our recommendations for choosing an approach.
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Kidney international · Dec 2009
Systematic reviews and meta-analyses: when they are useful and when to be careful.
Systematic reviews and meta-analyses are increasingly popular study designs in clinical research. A systematic review is a summary of the medical literature that uses explicit and reproducible methods for searching the literature and critical appraisal of individual studies; in contrast, a meta-analysis is a mathematical synthesis of the results of these individual studies. These study designs can be useful tools for summarizing the increasing amount of knowledge that is gained from scientific papers on a certain topic. ⋯ Although the specific methodology of systematic reviews includes steps to minimize bias in all stages of the process, investigators should be aware of potential biases such as poor quality of included studies, heterogeneity between studies, and the presence of publication and outcome reporting bias. This paper explains how systematic reviews and meta-analyses should be performed and how to interpret and implement their results. In addition, we discuss when meta-analyses are useful and when they are not.
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Kidney international · Nov 2009
ReviewHealth related quality of life and the CKD patient: challenges for the nephrology community.
The compromised health-related quality of life (HRQOL) of patients with chronic kidney disease is now well documented. The recent mandate by the Center for Medicare Services in the United States that all dialysis units monitor HRQOL as a condition of coverage has focused attention on the importance of these measures. ⋯ Can HRQOL of these patients be improved? The present review addresses this issue by commenting on strategies that have been used to improve the HRQOL of chronic kidney disease patients. A systematic approach is suggested for nephrology care providers to attempt to evaluate and improve the HRQOL of CKD patients.
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Hemodialysis patients have greater morbidity and mortality when they have a catheter rather than an arteriovenous fistula access. Catheter infection plays a significant role in this effect. Inflammation associated with dialysis catheter use could have an independent adverse effect on patient outcomes. Awareness and further study of the role of inflammation are needed.