Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jul 2012
Timing of initiation of renal replacement therapy for acute kidney injury: a survey of nephrologists and intensivists in Canada.
Little is known about factors that influence the timing of initiation of renal replacement therapy (RRT) for acute kidney injury (AKI). We sought to better describe these factors for Canadian physicians that prescribe RRT for AKI. ⋯ These results provide insight into clinical and laboratory factors that influence the timing of initiation of RRT for AKI and may aid in the design of future trials. While most clinicians consider the degree of hyperkalemia and pulmonary edema in deciding when to initiate RRT for AKI, there is a wide range of clinical practice, uncertainty regarding the optimal timing of initiation and enthusiasm for prospective interventional studies to address this topic.
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Nephrol. Dial. Transplant. · Jun 2012
Clinical TrialThe fallacy of the BUN:creatinine ratio in critically ill patients.
Acute kidney injury (AKI) is common in critically ill patients and is associated with a high mortality rate. Pre-renal azotemia, suggested by a high blood urea nitrogen to serum creatinine (BUN:Cr) ratio (BCR), has traditionally been associated with a better prognosis than other forms of AKI. Whether this pertains to critically ill patients is unknown. ⋯ A BCR >20 is associated with increased mortality in critically ill patients. It is also associated with a lower likelihood of RRT, perhaps because of misinterpretation of the BCR. Clinicians should not use a BCR >20 to classify AKI in critically ill patients.
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Nephrol. Dial. Transplant. · Jun 2012
Tissue inhibitor of metalloproteinases (TIMP-1), genetic markers of insulin resistance and cardiomyopathy in patients with kidney failure.
Left ventricular hypertrophy (LVH) is a major cardiovascular (CV) complication in patients with kidney failure, and an association between polymorphisms in the ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) gene, a genetic marker of insulin resistance, and LVH and Left ventricular (LV) concentric remodelling has been recently documented in these patients. Aims. Since myocardial fibrosis is a prominent feature in LVH induced by insulin resistance, we tested the hypothesis that the interaction between ENPP1 rs1974201 and rs9402349 polymorphisms and the tissue inhibitor of metalloproteinases (TIMP-1)--a pro-fibrotic protein which inhibits extracellular matrix degradation--is implicated in concentric LVH and diastolic dysfunction in a cohort of 223 dialysis patients. ⋯ In dialysis patients, the ENPP1 rs1974201 polymorphism modifies the association between TIMP-1 and LV geometry and diastolic function. These results are consistent with the hypothesis that insulin resistance is involved not only in LVH but also in myocardial fibrosis, an alteration of primary importance in the high risk of this population.
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Nephrol. Dial. Transplant. · Jun 2012
The evolution of renal function and the incidence of end-stage renal disease in patients aged ≥ 50 years.
The prevalence of chronic kidney disease (CKD) is high, especially among older patients. ⋯ Baseline eGFR, diabetes, high cholesterol, high LDL, hypertension and female gender are independent risk factors for developing ESRD. Older age at baseline predicts a lower risk.
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Nephrol. Dial. Transplant. · Jun 2012
Renal replacement therapy in critically ill patients with acute kidney injury--when to start.
Despite the frequent use of renal replacement therapy (RRT) for patients with acute kidney injury (AKI) in the intensive care unit (ICU), there is no accepted consensus on the optimal indications and timing. ⋯ Available evidence suggests that the decision when to start RRT in critically ill patients with AKI should be based on trends in the patient's severity of illness, presence of oliguria and fluid overload and associated non-renal organ failure rather than specific serum creatinine or urea values.