Journal of nephrology
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Journal of nephrology · Jan 2012
Meta AnalysisA population-based approach for the definition of chronic kidney disease: the CKD Prognosis Consortium.
The Kidney Disease: Improving Global Outcomes (KDIGO) foundation promoted the establishment of the Chronic Kidney Disease (CKD) Prognosis Consortium to meta-analyze the association of estimated glomerular filtration rate (eGFR) and albuminuria with incidence of various outcomes in samples of general populations from all over the world. ⋯ Data support the threshold of 60 ml/min for CKD definition but suggest that eGFR in the range 60-74 ml/min could represent the early stages of CKD. This first set of results of the CKD Prognosis Consortium represents an important step in the evidence-based definition of CKD. Conclusions should be reevaluated with eGFR calculation by equations less biased for normal-high eGFR.
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Acute kidney injury (AKI) is associated with significant morbidity, mortality, and health care costs. In spite of significant advances in health-care technology over the past few years, the incidence of AKI appears to be increasing over time. Elderly subjects represent the segment of the general population in which the incidence of AKI has been increasing the most. ⋯ In the last few years, several studies have suggested new biomarkers that may help the physician to better define AKI overall and in elderly patients in particular. The prevention of AKI is a crucial consideration in the management of elderly patients, since they are at high risk of developing AKI and in this particular population AKI is associated with significantly increased morbidity and mortality. Improved awareness, aiming for early detection, and implementation of preventive strategies, might lead to a decreased incidence of AKI and better outcomes in elderly patients.
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Journal of nephrology · Jan 2012
ReviewAcute renal failure in the elderly: epidemiology and clinical features.
Structural and functional alterations affecting the aging kidney predispose to an increased risk of acute renal failure (ARF) in the elderly. This is a common problem becoming more relevant because of an increase in life expectancy. The epidemiology of ARF in the elderly is far from being well assessed, because of the lack of uniform definition criteria, variable etiology, coexistence of several comorbidities, and the various clinical settings and geographic areas where the condition is managed, with a higher incidence in developed regions where elderly patients predominate. ⋯ Although in elderly patients the more frequent forms of AKI are functional or obstructive, parenchymal AKI, such as acute tubular necrosis and contrast-induced nephropathy, still frequently occur. Elderly patients with chronic renal disease (CKD) who develop AKI are at high risk for mortality, and are prone to non-recovery from AKI and progression to more advanced stages of CKD and even to end-stage renal disease. Panels of AKI biomarkers are likely to improve early diagnosis and treatment, thus reducing morbidity and mortality of older patients from this condition in the future.
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Journal of nephrology · Jan 2012
Regional citrate anticoagulation in critically ill patients with liver and kidney failure.
Regional citrate anticoagulation (RCA) is being used increasingly in critically ill patients who require continuous renal replacement therapy (CRRT). RCA may be avoided in patients with liver disease because of perceived increased risk of metabolic complications. The study compares the circuit lifespan and metabolic complications using RCA for CRRT at varying levels of liver dysfunction. ⋯ RCA is a reasonably safe form of anticoagulation for maintaining efficiency and patency of the dialyzer in critically ill patients with liver dysfunction.