American journal of kidney diseases : the official journal of the National Kidney Foundation
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Comparative Study
Children on long-term dialysis in the United States: findings from the 2005 ESRD clinical performance measures project.
The Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures (CPM) Project contains one of the largest databases of prevalent pediatric dialysis patients in the United States. Since 2005, the CPM Project has included not only children on long-term hemodialysis (HD) therapy, but also those on long-term peritoneal dialysis (PD) therapy. This study describes demographic and clinical characteristics and compares them between patients on HD and PD therapy. ⋯ A significant number of children had hemoglobin, serum albumin, and/or Kt/V values outside the recommended targets. Future research is needed to better define the risk relationships of these predictors with morbidity and mortality in children on dialysis therapy, evaluate the benefit of treating to certain treatment targets, and understand reasons for failing to reach treatment targets in individual patients or patient groups.
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Clinical Trial
Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial.
Nondipping status is associated with greater cardiovascular morbidity and mortality and faster progression of chronic kidney disease (CKD). We examined whether shifting 1 antihypertensive drug from morning to evening restores the circadian rhythm of blood pressure in nondipper patients with CKD. ⋯ In nondipper patients with CKD, changing the timing of antihypertensive therapy decreases nocturnal blood pressure and proteinuria.
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Hypernatremia is common in the intensive care unit (ICU). We assessed the prevalence of hypernatremia and its impact on mortality and ICU length of stay (LOS). ⋯ Most cases of hypernatremia in the ICU developed after admission, suggesting an iatrogenic component in its evolution. Hypernatremia is associated with increased mortality. Strategies for preventing hypernatremia in the ICU should be encouraged.