Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Feb 2011
Multicenter Study Clinical TrialOutcomes of cancer and non-cancer patients with acute kidney injury and need of renal replacement therapy admitted to general intensive care units.
Studies on cancer patients with acute kidney injury (AKI) are restricted to specialized intensive care units (ICUs). The aim of this study was to compare the characteristics and outcomes of cancer and non-cancer patients requiring renal replacement therapy (RRT) for AKI in general ICUs. ⋯ In general ICUs, one in six patients requiring RRT has cancer. Despite a relatively higher mortality, the presence of cancer was not independently associated with mortality in the present cohort.
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Nephrol. Dial. Transplant. · Feb 2011
Defining urine output criterion for acute kidney injury in critically ill patients.
The widespread use of RIFLE and AKIN classification systems for acute kidney injury (AKI) diagnosis and staging has established the association between AKI severity and adverse outcomes. However, as a result of the difficulties in measuring and recording the urine output every hour, a few prospective studies have validated the urine output criterion as stated in these classification systems. We assessed hourly urine output in ICU patients using an automated and accurate device to determine if changes in urine flow and volume could be a sensitive marker of AKI. Additionally, we assessed various definitions of oliguria to determine whether measurement of urine output using a fixed 6-h interval that matches nurses' shifts would be equivalent to the current standard for AKI diagnosis and staging. ⋯ Episodes of oliguria occur frequently in ICU patients and identify a higher percentage of AKI patients compared to serum creatinine criterion. Alterations in urine flow may be a sensitive marker of renal dysfunction and need to be validated in larger cohorts.
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Nephrol. Dial. Transplant. · Feb 2011
Osteopontin predicts survival in critically ill patients with acute kidney injury.
The cytokine osteopontin is involved in the pathophysiology of experimental acute kidney injury. We have tested the hypothesis that osteopontin levels might serve as a biomarker predicting outcome in critically ill patients requiring renal replacement therapy after acute kidney injury. ⋯ Osteopontin may serve as a novel biomarker for both, overall survival and renal outcome in critically ill patients with acute kidney injury, that require renal replacement therapy.
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Nephrol. Dial. Transplant. · Jan 2011
Randomized Controlled Trial Multicenter Study Comparative StudyRegional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial.
Continuous venovenous haemofiltration (CVVH) in the intensive care setting requires anticoagulation to prevent clotting of the extracorporeal circuit. Several protocols avoiding heparin and using regional citrate anticoagulation have been developed to diminish bleeding risks. However, data from randomized trials comparing citrate anticoagulation with systemic heparinization are very limited. ⋯ Citrate may be used as a regional anticoagulant and the only buffering agent in CVVH with adequate treatment efficacy and safety. However, neither citrate nor heparin anticoagulation should be regarded as a therapeutic standard, since there is no advantage of one of these substances with regard to patient mortality.