Seminars in dialysis
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Seminars in dialysis · Mar 2011
ReviewAdvances in pediatric renal replacement therapy for acute kidney injury.
The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980s, intrinsic renal disease and burns comprised the most common pediatric acute renal failure etiologies; more recent data demonstrate that pediatric acute kidney injury (AKI) most often results from complications of other systemic diseases resulting from the advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. ⋯ In this article, we aim to review the pediatric specific causes for RRT provision, emphasizing the emerging practice patterns with respect to modality and timing of treatment. We will focus on the application of different RRT modalities and related outcome of children with AKI who receive RRT.
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Renal replacement therapies (RRTs) are frequently employed for treatment of patients suffering from acute kidney injury in the intensive care unit (ICU). Multiple modalities of RRT are currently available. ⋯ Because of the high complexity of ICU patients, physicians must be aware of the limitations and complications of both intermittent and continuous dialysis modalities that can contribute to patient morbidity and mortality. In this article, we highlight the recognized complications of RRTs and the treatment approach to these complications.
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Seminars in dialysis · Mar 2011
Nursing issues in renal replacement therapy: organization, manpower assessment, competency evaluation and quality improvement processes.
For the patient with acute kidney injury, continuous renal replacement therapy (CRRT) is a treatment option that has application for the hemodynamically unstable critically ill patient. The decision to initiate a continuous renal replacement modality depends not only on the physician, either the nephrologist or intensivist, but also on the availability of specially trained nursing resources. This article will explore the nursing collaborative model of care at a large university-based research and teaching Medical Center in Southern California. The focus will be on nursing issues in CRRT including organization of educational programs, manpower assessment, competency evaluation, and quality improvement processes.
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Seminars in dialysis · Jan 2011
Case ReportsAbdominal catastrophe in a 43-year-old female with end stage renal disease.
A 43-year-old female with end-stage renal disease secondary to focal segmental glomerulosclerosis was admitted to the hospital for shortness of breath after missing hemodialysis. On admission, the patient was noted to have painful skin lesions consistent with calciphylaxis on biopsy. While undergoing aggressive wound care, she developed altered mental status and was found to be septic and started empirically on broad-spectrum antibiotics. ⋯ The patient expired on day 26 of admission. An autopsy revealed calciphylaxis within the gut wall and within the dura of the central nervous system. While typically a disorder of subcutaneous tissue, calciphylaxis can affect internal organs, which in this case resulted in a catastrophic outcome.
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Seminars in dialysis · Jan 2011
EditorialCherry picking in ESRD: an ethical challenge in the era of pay for performance.
In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, self-interest could lead nephrologists toward cherry picking dialysis patients. Cherry picking, however, is morally problematic. ⋯ Second, it involves shifting the burden of caring for sicker (and less financially attractive) patients to other nephrologists and dialysis units that do not practice cherry picking, creating injustices in the health care system. Finally, it treats patients as mere means through which nephrologists achieve reimbursement instead of as persons possessing dignity and deserving of respect.