Masui. The Japanese journal of anesthesiology
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Chronic kidney disease (CKD), defined by abnormalities in kidney function or damage stable for more than three months, is a relatively common disease in Japan. A high prevalence of pain-associated disease is reported in the CKD population. ⋯ Furthermore, certain analgesics can increase the risk of acute kidney injury and they should be avoided in CKD patients. The aim of this article is to review the considerations needed for pain management in CKD patients.
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Chronic kidney disease (CKD) often accompanies cardiovascular complications, causing postoperative morbidity and even mortality. Since fluid and electrolyte homeostasis is deregulated in CKD patients, fluid therapy itself may cause postoperative morbidity. Recent studies have shown that forced diuresis through fluid overload offers no renoprotective effect and instead has harmful consequences. ⋯ The regulation of renal function through the endocrine system (i.e., renin-angiotensin-aldosterone and vasopressin) is a key target for protecting the kidney in CKD. The recent development of a receptor blocker targeting these endocrine systems may be beneficial for correcting the fluid balance caused by excess intraoperative fluid therapy. The main issue for fluid therapy in surgical CKD patients may not be the quantity of fluid, but rational intervention affecting the endocrine system.
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Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. ⋯ Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.
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To avoid perioperative cardiac complications and deterioration of renal function in chronic kidney disease (CKD), anesthesiologists are required to manage respiration and circulation properly. Three mechanisms are considered to worsen renal function during inappropriate mechanical ventilation; first, hypercapnia or hypoxemia, second, unstable systemic hemodynamic, and third, systemic inflammatory mediators derived from pulmonary biotrauma. Many circulatory problems are present in CKD patients, for example, hypertension, cardiac hypertrophy, cardiomyopathy, ischemic heart disease, arterial sclerotic valve disease, salt and water retention etc. ⋯ Appropriate hemodynamic monitoring, including direct arterial pressure, left ventricular preload, intravascular volume and cardiac output could be helpful for anesthesiologists to manage CKD patients safely. In the area of CKD and anesthesia, there is lack of evidence in respiratory and circulatory strategies. Prospective studies in these aspects are required in the future.
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The concept and the definition of CKD proposed by The National Kidney Foundation (USA) have been there for 10 years. The Japanese Society of Nephrology also has conducted the education and the spread of CKD. Consequently, in 2009 the newly introduced dialysis patients reached the ceiling in number in Japan. Definition, diagnosis, grading and the treatment of CKD published in 2012 by The Japanese Society of Nephrology were reviewed in this article.