American journal of kidney diseases : the official journal of the National Kidney Foundation
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Chronic pain frequently is associated with autosomal dominant polycystic kidney disease and is a significant cause of morbidity. The classic approach to treat pain in patients with this disease starts with nonpharmacologic therapy and progresses to high-dose opioid therapy and more invasive procedures, including surgery. We present the case of a 43-year-old white woman presenting in our clinic with poorly controlled chronic left flank and epigastric pain secondary to autosomal dominant polycystic kidney disease despite high-dose opioids and multiple cyst decompression procedures. After temporarily successful management with celiac plexus neurolysis and intercostal nerve radiofrequency ablations for years, the next more permanent step was dorsal column neurostimulation, affording excellent analgesia with significantly improved quality of life to this day.
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Review Meta Analysis Comparative Study
Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a meta-analysis of randomized controlled trials.
Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it may increase the risk of bleeding. Regional citrate anticoagulation reduces the risk of bleeding, but may cause hypocalcemia and metabolic disturbances. ⋯ The efficacy of citrate and heparin anticoagulation for CRRT was similar. However, citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis. We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding.
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Comparative Study
Age and the associations of living donor and expanded criteria donor kidneys with kidney transplant outcomes.
Recent studies show a survival advantage with kidney transplant in elderly patients compared with those on dialysis therapy. ⋯ For deceased donors, ECD kidneys are not associated with increased mortality or transplant failure in recipients older than 70 years. For all types of donors, the persistent association between living donor kidneys and lower all-cause mortality across all ages suggests that, if possible, elderly patients gain longevity from living donor kidney transplant.
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Comparative Study
Center-level factors and racial disparities in living donor kidney transplantation.
On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. ⋯ Racial disparity in attainment of LDKT exists at every transplant center in the country. Centers with higher rates of LDKT attainment for all races had less disparity; these high-performing centers might provide insights into policies that might help address this disparity.
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Comparative Study
GFR and cardiovascular outcomes after acute myocardial infarction: results from the Korea Acute Myocardial Infarction Registry.
Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined. ⋯ eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.