Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Oct 2007
ReviewInsulin therapy and acute kidney injury in critically ill patients a systematic review.
Intensive insulin therapy has been found to reduce mortality in some critically ill patients. We performed a systematic review and meta-analysis to ascertain the effect of intensive insulin therapy on the incidence of acute kidney injury (AKI) in adult critically ill patients. ⋯ There is evidence that intensive insulin therapy initiated in critically ill adult patients is associated with a reduction in the incidence of AKI in medical and surgical settings. A large trial primarily designed to examine the effect of insulin on the prevention of AKI is needed to confirm this finding.
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Nephrol. Dial. Transplant. · Oct 2007
ReviewAutomated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials.
A systematic review of randomized controlled trials (RCTs) comparing continuous ambulatory peritoneal dialysis (CAPD) with all forms of automated peritoneal dialysis (APD) was performed to assess their comparative clinical effectiveness. ⋯ APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that impact on patients' quality of life. Further, adequately powered trials are required to confirm the benefits for APD found in this review and detect differences with respect to other clinically important outcomes that may have been missed by the trials included in this review due to their small size and short follow-up periods.
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Nephrol. Dial. Transplant. · Oct 2007
How much is catheter flow influenced by the use of closed luer lock access devices?
To reduce infection risks in patients on hemodialysis with a long term central venous catheter, different types of closed luer lock access devices are used on the arterial and venous catheter hub. Although those connectors create a mechanically and microbiologically closed system in between two dialysis sessions, no data are available on the resistance those connectors exert on the blood flow during dialysis. Therefore, in the present study, flow resistance was determined in three different connectors. ⋯ In conclusion, the Tego and Codan connector show promising results for the use on a catheter hub during and in between dialysis sessions. Whether those resistances are in the safe range without the incidence of blood hemolysis will soon be investigated in an in vivo study.
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Nephrol. Dial. Transplant. · Oct 2007
In severe acute kidney injury, a higher serum creatinine is paradoxically associated with better patient survival.
Lack of precise, reliable and consistent measures of kidney dysfunction in acute kidney injury (AKI) causes uncertainty in the definition and management of this important condition and interferes with treatment standardization. Serum creatinine (SCr) remains a key determinant in the management of renal dysfunction. In disparate populations, previous authors suggested a paradoxical association between higher SCr and better survival. ⋯ Inversely, a lower SCr may be an indication of fluid overload, associated with worse survival. Our findings did not support a role of nutrition or muscle mass for this association. All these possibilities are worthy of thorough investigation, as findings will likely result in important changes in patient outcome.