Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Oct 2011
Randomized Controlled TrialIntroduction of the CKD-EPI equation to estimate glomerular filtration rate in a Caucasian population.
Chronic kidney disease (CKD) is defined as the presence of kidney damage, albuminuria or a reduction in glomerular filtration rate (GFR). A GFR <60 mL/min/1.73 m(2) alone is sufficient to diagnose CKD Stages III-V. Recently, the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation was introduced. It has been suggested to result in higher estimated glomerular filtration rates (eGFRs) than the Modification of Diet in Renal Disease (MDRD(4)) formula. Here, we assess consequences of introducing the CKD-EPI equation in a West European Caucasian population. ⋯ In comparison with the MDRD(4) formula, the CKD-EPI equation leads to higher estimates of GFR in young people and lower estimates in the elderly. On a population level, this may lead to higher estimates of kidney function. However, in routine clinical practice where the population is predominantly elderly, the opposite may be true. The introduction of eGFR(CKD-EPI) necessitates reconsidering the definition of CKD. We suggest introducing age-dependent threshold values and/or the use of urinary albumin excretion to improve risk stratification.
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Nephrol. Dial. Transplant. · Oct 2011
Comparative StudyComparison of bioimpedance methods for estimating total body water and intracellular water changes during hemodialysis.
The accurate assessment of body fluid volume is important in many clinical situations. Hannan et al. proposed a single-frequency bioimpedance equation (HE) to calculate extracellular water (ECW) and total body water (TBW). There are two equations based on the bioimpedance spectroscopy (BIS) method for the evaluation of body fluid volume: Xitron equations (XE) and body composition spectroscopy equations (BCSE). The aim of the study was to compare the accuracy of these three equations in body fluid volume point estimation in maintenance hemodialysis (MHD) patients. ⋯ Our study indicated that BCSE provided a better point estimation of ICW and TBW.
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Nephrol. Dial. Transplant. · Oct 2011
Comparative StudyUrinary kidney injury molecule-1 in patients with IgA nephropathy is closely associated with disease severity.
The pathological characteristics of IgA nephropathy (IgAN) are highly variable. Urinary kidney injury molecule-1 (KIM-1) is a sensitive biomarker for proximal tubule injury. The aim of the study is to investigate the value of KIM-1 as a biomarker for assessing the renal injury in IgAN. ⋯ Urinary KIM-1 may be a useful biomarker to evaluate kidney injury in IgAN.
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Nephrol. Dial. Transplant. · Oct 2011
Early nephrology consultation can have an impact on outcome of acute kidney injury patients.
Patients who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The objectives of this study were to compare clinical and laboratory characteristics of AKI patients evaluated and not evaluated by nephrologists in ICU and generate the hypothesis of the relationship between timing of nephrology consultation and outcome. ⋯ In AKI, patients evaluated by nephrologists seem to be more seriously ill than those not evaluated and present similar mortality rate. The delayed nephrology consultation can be associated with increased ICU mortality.
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Nephrol. Dial. Transplant. · Oct 2011
Remote ischaemic preconditioning by brief hind limb ischaemia protects against renal ischaemia-reperfusion injury: the role of adenosine.
Remote ischaemic preconditioning (RIPC) is a strategy to protect a target organ against ischaemia-reperfusion injury (IRI) by inducing short-term ischaemia/reperfusion (I/R) in a remote organ. RIPC of the kidney by temporary limb occlusion would be a safe, inexpensive and noninvasive method to prevent renal damage in, e.g., transplantation and aortic surgery. We investigated whether brief hind limb occlusion can protect against renal IRI and whether this protection is adenosine dependent. ⋯ Brief hind limb ischaemia induces protection against renal IRI, which makes this a promising strategy to prevent renal IRI in a clinical setting. Bilateral RIPC was more effective than unilateral RIPC, and this protection occurs via an adenosine-independent mechanism.