Clin Nephrol
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Continuous renal replacement therapy (CRRT) has become an important multiple organ support therapy and it is widely used in the intensive care unit (ICU). The aim of this study was to clarify the association between CRRT and 28-day mortality in critically ill coronavirus disease 2019 (-COVID-19) patients receiving mechanical ventilation. ⋯ AKI prevalence and 28-day mortality are high in critically ill patients with COVID-19 receiving mechanical ventilation. CRRT plays a part in decreasing the mortality of critically ill COVID-19 patients with AKI receiving mechanical ventilation.
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In the current political environment, the plight of undocumented immigrants in the United States (U. S.) remains perilous and uncertain, and this precarious situation is magnified for undocumented immigrants with end-stage renal disease (ESRD). For this population, access to hemodialysis varies dramatically from standard-of-care thrice-weekly hemodialysis, to the other extreme of emergency-only hemodialysis which is the practice of offering hemodialysis only after a patient meets "critically ill criteria." Due to the exclusion from Medicare, undocumented immigrants are not included in the United States Renal Data System (USRDS), and therefore the prevalence of undocumented immigrants with ESRD in the U. ⋯ Hispanics with Medicare to undocumented immigrants would likely overestimate the undocumented immigrant population with ESRD given the younger age of the immigrant population. Applying the estimates from the states with the largest population of undocumented immigrants, the range for California and Texas is 500 - 798 PMP which results in an estimate of 5,500 - 8,857 undocumented immigrants with ESRD living in the U. S.
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The implantation of acute or chronic vascular accesses for hemodialysis (HD) in end-stage kidney disease patients is a critical skill procedure for nephrologists, with an impact on short- and long-term outcomes of the modality and patient survival. Placement circumstances, however, may depend on the availability of technological support and will likely vary across the world. ⋯ Technologically successful TDC placement can be performed without fluoroscopic tip guidance and result in improved access flows and dialysis efficacy when compared to temporary hemodialysis catheters.
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Contrast-induced acute kidney injury (CI-AKI) is a major complication after coronary angiography (CAG) or percutaneous coronary intervention (PCI) and is associated with increased morbidity and mortality. It remains controversial whether renin-angiotensin system (RAS) blockers increase or decrease CI-AKI. In this meta-analysis, we investigated the association between RAS blockers and CI-AKI in patients with normal kidney function or mild-to-moderate chronic kidney disease (CKD). ⋯ In patients with relatively-preserved renal function, the association of RAS blockers with an increased risk of CI-AKI after contrast media exposure was inconclusive, as sensitivity analysis showed conflicting results and bias. Although this study did not demonstrate significant evidence, it indicated that clinicians need to be vigilant in assessing the potential risk for RAS blockers to cause CI-AKI in low-risk patients.