Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Mar 2012
Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury.
Patients with acute kidney injury (AKI) requiring initiation of renal replacement therapy (RRT) have poor short- and long-term outcomes, including the development of dialysis dependence. Currently, little is known about what factors may predict renal recovery in this population. ⋯ In patients with AKI, a higher degree of fluid overload at RRT initiation predicts worse renal recovery at 1 year. Clinical trials are needed to determine whether interventions targeting fluid overload may improve patient and renal outcomes.
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Nephrol. Dial. Transplant. · Mar 2012
Osmotic diuresis due to urea as the cause of hypernatraemia in critically ill patients.
Hypernatraemia is common in critically ill patients and has been shown to be an independent predictor of mortality. Osmotic urea diuresis can cause hypernatraemia due to significant water losses but is often not diagnosed. Free water clearance (FWC) and electrolyte free water clearance (EFWC) were proposed to quantify renal water handling. We aimed to (i) identify patients with hypernatraemia due to osmotic urea diuresis and (ii) investigate whether FWC and EFWC are helpful in identifying renal loss of free water. ⋯ Osmotic urea diuresis is a common cause of hypernatraemia in the ICU. EFWC was useful in the differential diagnosis of polyuria during rising serum sodium levels, while FWC was misleading.
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Nephrol. Dial. Transplant. · Mar 2012
Randomized Controlled Trial Clinical TrialEffect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single-center randomized clinical trial.
Acute kidney injury (AKI) is a major complication in patients with sepsis and is an independent predictor of mortality. However, the optimal intensity of renal replacement therapy for such patients is still controversial. ⋯ In patients with sepsis and AKI, increasing the intensity of renal replacement therapy from 50 (HVHF) to 85 mL/kg/h (EHVHF) had no effect on survival at 28 and 90 days.
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Nephrol. Dial. Transplant. · Mar 2012
Comparative StudyPharmacokinetics of sulfobutylether-β-cyclodextrin (SBECD) in subjects on hemodialysis.
The disposition of sulfobutylether-β-cyclodextrin (SBECD), the solubilizing excipient in intravenous (i.v.) voriconazole, was assessed in seven male subjects with end-stage renal disease on hemodialysis and six subjects with normal renal function. ⋯ Hemodialysis can significantly reduce levels of SBECD in subjects with end-stage renal disease.
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Nephrol. Dial. Transplant. · Mar 2012
ReviewSignificance of hypo- and hypernatremia in chronic kidney disease.
Both hypo- and hypernatremia are common conditions, especially in hospitalized patients and in patients with various comorbid conditions such as congestive heart failure or liver cirrhosis. Abnormal serum sodium levels have been associated with increased mortality in numerous observational studies. ⋯ To date, there has been a paucity of population-wide assessments of the incidence and prevalence of dysnatremias, their clinical characteristics and the outcomes associated with them in patients with various stages of CKD. We review the physiology and pathophysiology of water homeostasis with special emphasis on changes occurring in CKD, the outcomes associated with abnormal serum sodium in patients with normal kidney function and the results of recent studies in patients with various stages of CKD, which indicate a substantial incidence and prevalence and significant adverse outcomes associated with dysnatremias in this patient population.