Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Nov 2011
Acute kidney injury in patients admitted to a liver intensive therapy unit with paracetamol-induced hepatotoxicity.
Paracetamol overdose can cause acute kidney injury (AKI) independent of its hepatotoxic effects. We aimed to determine the prevalence of AKI (AKI Network definition) in those with paracetamol-induced hepatotoxicity, identify factors associated with development, assess impact on the outcomes of patient survival and length of stay and determine the proportion of patients recovering renal function (estimated glomerular filtration rate > 60 mL/min) by the time of hospital discharge or transfer out. ⋯ AKI is very common in critically ill patients with paracetamol-induced hepatotoxicity requiring LITU admission. Although outcomes are poorer with AKI than with normal renal function, they are better than those found in other intensive therapy unit populations. Gradual recovery of renal function is seen in all patients.
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Nephrol. Dial. Transplant. · Nov 2011
Abdominal obesity is the most significant metabolic syndrome component predictive of cardiovascular events in chronic hemodialysis patients.
Five components of metabolic syndrome (MetS) have been identified as predictive of cardiovascular events (CVEs) in the general population: impaired fasting glucose, abdominal obesity, hypertriglyceridemia, hypertension and low high-density lipoprotein cholesterol. Whether MetS and its components are also predictive of CVEs in chronic hemodialysis (HD) patients remains unclear. We therefore investigated the role of MetS and its components in patients on chronic HD. ⋯ IDF-defined MetS was more predictive of CVEs than AHA/NHLBI-defined MetS. Of the MetS components, abdominal obesity was the single most significant predictor of CVEs in chronic HD patients.
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Nephrol. Dial. Transplant. · Oct 2011
Clinical TrialImpact of blood volume monitoring on fluid removal during intermittent hemodialysis of critically ill children with acute kidney injury.
In chronic pediatric patients treated with intermittent hemodialysis (IHD), blood volume monitoring (BVM) is commonly used to assess and manage volume status during the dialysis session. Minimal data exists on its use during IHD in critically ill children with acute kidney injury (AKI). In these cases, fluid removal may be limited by hemodynamic instability. ⋯ In conclusion, in our experience of IHD sessions in critically ill children with AKI, the use of BVM allowed a higher UF in those with BVM without influencing the frequency of hypotensive episodes. Applying specific guidelines on BVM use may decrease hypotensive episodes during IHD treatment in critically ill patients.
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Nephrol. Dial. Transplant. · Oct 2011
Serum urea concentration is probably not related to outcome in ICU patients with AKI and renal replacement therapy.
Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit (ICU). Among other variables, serum urea concentrations are recommended for timing of initiation of renal replacement therapy (RRT). The aim of this study was to evaluate whether serum urea concentration or different serum urea concentration cutoffs as recommended in the literature were associated with in-hospital mortality at time of initiation of RRT for AKI. ⋯ This retrospective study suggests that serum urea concentration and serum urea concentration cut-offs at time of initiation of RRT have no predictive value for in-hospital mortality in ICU patients with AKI.
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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.