American journal of kidney diseases : the official journal of the National Kidney Foundation
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Sudden cardiac death constitutes the leading cause of death in patients receiving dialysis. Little is known about the trends in implantable cardioverter-defibrillator (ICD) use and the outcomes of such device placement. ⋯ ICD use in dialysis patients is increasing, but rates of all-cause and cardiovascular mortality remain high in dialysis patients receiving these devices. Device infections are common, particularly in patients with recent infections. Randomized trials of ICDs are needed to determine the efficacy, safety, and risk-benefit ratio of these devices in dialysis patients.
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Review Meta Analysis
Cystatin C in prediction of acute kidney injury: a systemic review and meta-analysis.
Cystatin C (CysC) has been proposed as a filtration marker for the early detection of acute kidney injury (AKI); however, a wide range of its predictive accuracy has been reported. ⋯ Serum CysC appears to be a good biomarker in the prediction of AKI, whereas urinary CysC excretion has only moderate diagnostic value.
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Case Reports
Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis.
An increase in serum osmolality and serum osmolal gap with or without high-anion-gap metabolic acidosis is an important clue to exposure to one of the toxic alcohols, which include methanol, ethylene glycol, diethylene glycol, propylene glycol, or isopropanol. However, the increase in serum osmolal gap and metabolic acidosis can occur either together or alone depending on several factors, including baseline serum osmolal gap, molecular weight of the alcohol, and stage of metabolism of the alcohol. ⋯ It is essential for clinicians to understand the value and limitations of osmolal gap to assist in reaching the correct diagnosis and initiating appropriate treatment. In this teaching case, we present a systematic approach to diagnosing high serum osmolality and increased serum osmolal gap with or without high-anion-gap metabolic acidosis.
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Review Meta Analysis
Smoking in dialysis patients: a systematic review and meta-analysis of mortality and cardiovascular morbidity.
Cigarette smoking is associated with increased cardiovascular morbidity and mortality in the general population, but the effect of smoking on these outcomes in the dialysis population is less well studied. ⋯ Active smoking is associated with a significant increase in all-cause mortality in dialysis patients, although there was no corresponding increased risk of cardiovascular events.
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Acute kidney injury (AKI) in hospitalized patients is associated with poor outcomes; however, it is unclear how relationships between AKI and clinical outcomes vary with baseline kidney function. ⋯ AKI of any severity increases the risk of death both during hospitalization and after discharge. Although the risk of developing ESRD after AKI is greatest in patients with baseline eGFR <30 mL/min/1.73 m(2), this is exceeded by the risk of death.