Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jul 2011
Multicenter StudyMortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries.
Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate. ⋯ Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.
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Nephrol. Dial. Transplant. · Jul 2011
Sleep-disordered breathing predicts cardiovascular events and mortality in hemodialysis patients.
Sleep-disordered breathing (SDB), characterized by repetitive apnea and hypopnea during sleep, is a risk factor for cardiovascular disease. However, the links between SDB and cardiovascular events in hemodialysis (HD) patients have not been clearly evaluated. ⋯ SDB is an independent risk factor for cardiovascular events and mortality in HD patients. Effective and earlier treatment for these patients is needed to improve clinical outcome.
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Nephrol. Dial. Transplant. · Jul 2011
The initial development and assessment of an automatic alert warning of acute kidney injury.
Acute kidney injury (AKI) recognition by clinicians has been shown to be suboptimal. Little work has focused on the use of an automated warning of a rise in a patient's creatinine, indicating AKI. ⋯ The alerts identified a group of AKI patients who are at moderately high risk of death. The prognostic score using a combination of covariates shows early promise. Both the alerts and the score warrant further development as tools for earlier intervention in AKI.
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Nephrol. Dial. Transplant. · Jul 2011
Effect of chronic kidney disease on the expression of thiamin and folic acid transporters.
Chronic kidney disease (CKD) is associated with significant cardiovascular, neurological and metabolic complications. Thiamin and folate are essential for growth, development and normal cellular function, and their uptake is mediated by regulated transport systems. While plasma folate and thiamin levels are generally normal in patients with CKD, they commonly exhibit features resembling vitamin deficiency states. Earlier studies have documented impaired intestinal absorption of several B vitamins in experimental CKD. In this study, we explored the effect of CKD on expression of folate and thiamin transporters in the key organs and tissues. ⋯ CKD results in marked down-regulation in the expression of folate and thiamin transporters in the intestine, heart, liver and brain. These events can lead to reduced intestinal absorption and impaired cellular homeostasis of these essential micronutrients despite their normal plasma levels.
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Nephrol. Dial. Transplant. · Jun 2011
Effects of chronic kidney disease and post-angiographic acute kidney injury on long-term prognosis after coronary artery angiography.
Both chronic kidney disease (CKD) and post-angiographic acute kidney injury (AKI) are regarded as risks factors for long-term mortality after coronary angiography. On the other hand, acute haemodynamic disturbances requiring haemodynamic support have a strong impact on both the incidence of AKI and on prognosis after coronary angiography. The aim of this study was to determine the impact of CKD and AKI on long-term prognosis after coronary angiography among hospital survivors and to determine relationships with haemodynamic variables. ⋯ Among hospital survivors, CKD is an independent predictor for both long-term mortality and composite end points, regardless of haemodynamic conditions. AKI is also a predictor of long-term prognosis; however, its impact may be attenuated in haemodynamically stable hospital survivors.