American journal of kidney diseases : the official journal of the National Kidney Foundation
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The role of obesity as a risk factor for cardiovascular disease in patients with chronic kidney disease (CKD) is poorly understood. Waist-to-hip ratio (WHR) is less influenced by muscle and bone mass than body mass index (BMI). We compared WHR and BMI as risk factors for cardiac events (myocardial infarction and fatal coronary disease) in persons with CKD. ⋯ WHR, but not BMI, is associated with cardiac events in persons with CKD. Relying exclusively on BMI may underestimate the importance of obesity as a cardiovascular disease risk factor in persons with CKD.
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Nephrogenic systemic fibrosis (NSF) is a newly described disorder occurring in persons with renal failure. Gadolinium-based contrast used in magnetic resonance imaging (MRI) has been suggested as a cause. A cluster of patients with NSF was investigated to identify risk factors. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report. ⋯ Receipt of gadolinium-containing MRI contrast is associated with NSF in a dose-dependent manner. The risk associated with gadolinium may differ by contrast agent and dialysis modality. Use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure.
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Renal replacement therapies other than intermittent hemodialysis are often required in hemodynamically unstable patients. Continuous renal replacement therapies use a slow blood flow rate, necessitating anticoagulation and prolonged treatment times that may create difficulties with staffing and limit patient diagnostic and therapeutic procedures. We developed an alternative strategy based on a higher blood flow rate that allows increased rates of hemofiltration, no anticoagulation, and a shorter ("accelerated") treatment period. We report our technical and clinical experience with accelerated venovenous hemofiltration (AVVH). ⋯ AVVH is an alternate renal replacement therapy for patients in the intensive care unit and appears to provide adequate volume and solute control without the need for anticoagulation. The shorter treatment period offers flexibility for staffing and other patient diagnostic and therapeutic procedures.