American journal of kidney diseases : the official journal of the National Kidney Foundation
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Review Meta Analysis Comparative Study
Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery.
There is controversy about which dialytic modality should be used for the treatment of acute renal failure (ARF) in the intensive care unit. We performed a systematic review and meta-analysis to determine the relative risks (RRs) of mortality and renal recovery associated with intermittent hemodialysis (IHD) therapy compared with continuous renal replacement therapy (CRRT) in critically ill adults with ARF. ⋯ In comparison to IHD therapy, CRRT does not improve survival or renal recovery in unselected critically ill patients with ARF. Future studies should focus on well-defined subgroups of such patients using lessons learned from the trials in this meta-analysis. The high cost of chronic dialysis therapy and the relative instability of the RR for dialysis dependence suggest that future trials also should evaluate differences in renal recovery between dialytic modalities.
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A decrease in plasma sodium (P(Na)) concentration is common after surgery and attributed to the secretion of antidiuretic hormone in response to such nonosmotic stimuli as pain or nausea. In this setting, acute hyponatremia may lead to seizures, coma, and permanent neurological damage. Sporadic case reports have described severe neurological symptoms caused by hyponatremia occurring within hours after cardiac catheterization. We evaluated the prevalence, contributing clinical circumstances, and course of hyponatremia in patients undergoing cardiac catheterization. ⋯ An acute reduction in P(Na) level commonly occurs shortly after cardiac catheterization. The cause of hyponatremia appears to be related to the administration of hypotonic fluids, together with impaired urinary dilutional capacity. Although symptomatic hyponatremia is rare, the diagnosis should be entertained when neurological symptoms develop in this setting.