Clin Nephrol
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Nearly half of all non-dialysis chronic kidney disease (CKD) patients respond to iron therapy. Factors affecting anemia response to iron therapy are not well characterized. Oxidative stress (OS) is a recognized factor for anemia in CKD and promotes erythropoiesis stimulating agent (ESA) resistance; however, the influence in predicting response to intravenous (IV) iron has not been evaluated. ⋯ Decreased eGPx activity has adverse influences on response to FCM, suggesting that impaired erythrocyte antioxidant defense may be involved in the response to iron therapy in CKD patients.
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Regional citrate anticoagulation (RCA) is increasingly used in patients requiring continuous renal replacement therapy (CRRT). This study evaluated a new RCA protocol based on the Prismaflex® dialysis device and an isotonic citrate solution (prismocitrate) for pre-dilution continous veno-venous hemodiafiltration. ⋯ The evaluated Prismaflex®/ Prismocitrate-based citrate anticoagulation protocol provides insufficient control of blood acid-base and electrolyte balance.
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Comparative Study
Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis.
To compare long-term outcomes in CA-AKI to HA-AKI. The hypothesis was that renal and patient survival would be better in CA-AKI than in HA-AKI. ⋯ CA-AKI was found to be considerably more common than HA-AKI and had similar long-term consequences.
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End-stage renal disease (ESRD) carries a significant risk for sudden cardiac arrest (SCA), hospitalization and mortality. We present a case of a vintage hemodialysis patient who had a catastrophic event during his hemodialysis treatment - a sudden cardiac arrest. This case raises several important issues: First, patients with chronic kidney disease (CKD) (and particularly ESRD) are predisposed to an inordinate risk of SCA; second, the factors leading to SCA in CKD are unique; and lastly, it is of paramount importance to have basic life support training, crash carts and defibrillators in dialysis units. It also raises the important discussion regarding the role for automated implantable cardioverter defibrillators and medical therapy for the prevention of SCA in this population.
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Observational Study
Amino acid losses during sustained low efficiency dialysis in critically ill patients with acute kidney injury.
Sustained low efficiency dialysis (SLED) involves the use of standard dialysis machines for prolonged intermittent renal replacement therapy in critically ill patients. In this study we aimed to quantify dialysate amino acid (AA) and albumin losses in 5 patients who underwent successful SLED treatment. ⋯ During SLED with low-flux hemodialyzers, albumin losses are negligible but AA losses to dialysate are comparable to those during continuous renal replacement therapy. Patients' nutritional protein prescriptions should be augmented to account for this.