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Sample records for renal replacement modality

  1. [Peritoneal dialysis for acute renal failure: Rediscovery of an old modality of renal replacement therapy].

    Science.gov (United States)

    Issad, Belkacem; Rostoker, Guy; Bagnis, Corinne; Deray, Gilbert

    2016-07-01

    Acute renal failure (ARF) in adults in the intensive care unit (ICU) often evolves in a context of multiple organ failure, which explains the high mortality rate and increase treatment needs. Among, two modalities of renal replacement therapy, peritoneal dialysis (PD) was the first modality used for the treatment of ARF in the 1950s. Today, while PD is generalized for chronic renal failure treatment, its use in the ICU is limited, particularly, due to the advent of new hemodialysis techniques and the development of continuous replacement therapy. Recently, a renewed interest in the use of PD in patients with ARF has manifested in several emerging countries (Brazil, Vietnam). A systematic review in 2013 showed a similar mortality in ARF patients having PD (58%) and those treated by hemodialysis or hemodiafiltration/hemofiltration (56.1%). In the International society of peritoneal dialysis (ISPD)'s guideline (2013), PD may be used in adult ARF as the other blood extracorporeal epuration technics (recommendation with grade 1B). PD is the preferred method in cardiorenal syndromes, in frailty patients with hemodynamic instability and those lacking vascular access; finally PD is also an option in elderly and patients with bleeding tendency. In industrial countries, high volume automated PD with a flexible catheter (usually Tenckhoff) is advocated. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  2. Analysis of economic impact between the modality of renal replacement therapy.

    Science.gov (United States)

    Gouveia, Denise Sbrissia E Silva; Bignelli, Alexandre Tortoza; Hokazono, Silvia Regina; Danucalov, Itamara; Siemens, Tobias August; Meyer, Fernando; Santos, Luiz Sergio; Martins, Ziliane Caetano Lopes; Mierzwa, Tiago César; Furquim, Raquel

    2017-04-27

    Chronic kidney disease (CKD) is a major health problem, determining the reduction in life expectancy and an increased risk of cardiovascular disease. An observational, cohort, retrospective, based on patient's medical records data with CKD under hemodialysis, peritoneal dialysis and kidney transplantation in the city of Curitiba, in the period from January to June 2014, evacuativo the financial impact on the Unified Health System (SUS) and the supplementary health. The lowest cost of a kidney transplant in the first year was R$ 40,743.03 when cyclosporine was used and the highest was R$ 48,388.17 with the use of tacrolimus. In the second year post-transplant, hemodialysis and peritoneal dialysis have a higher cost compared to kidney transplant. Transplantation with deceased donor, treated with tacrolimus: R$ 67,023.39; Hemodialysis R$ 71,717.51 and automated peritoneal dialysis automatic R$ 69,527.03. After the first two years of renal replacement therapy, transplantation demonstrates lower costs to the system when compared to other modalities evaluated. Based on that, this therapy justifies improvements in government policies in this sector. A doença renal crônica (DRC) é um grande problema de saúde, determina redução na expectativa de vida e aumento dos riscos de doenças cardiovasculares. Estudo observacional, de coorte, retrospectivo, baseado em dados de prontuários de pacientes com DRC em hemodiálise, diálise peritoneal e transplante renal na cidade de Curitiba, no período de janeiro a junho de 2014, avaliando o impacto financeiro no Sistema Único de Saúde (SUS) e na saúde suplementar. O menor custo de um transplante renal no primeiro ano foi de R$ 40.743,03, quando utilizada a ciclosporina, e o maior de R$ 48.388,17, com a utilização do tacrolimo. Já no segundo ano pós-transplante, a hemodiálise e a diálise peritoneal têm valor superior ao transplante renal. Transplante com doador falecido, com tacrolimo: R$ 67.023,39; hemodiálise R$ 71

  3. Influence of Renal Replacement Modalities on Amikacin Population Pharmacokinetics in Critically Ill Patients on Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Roger, Claire; Wallis, Steven C; Muller, Laurent; Saissi, Gilbert; Lipman, Jeffrey; Lefrant, Jean-Yves; Roberts, Jason A

    2016-08-01

    The objective of this study was to describe amikacin pharmacokinetics (PK) in critically ill patients receiving equal doses (30 ml/kg of body weight/h) of continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF). Patients receiving amikacin and undergoing CVVH or CVVHDF were eligible. Population pharmacokinetic analysis and Monte Carlo simulation were undertaken using the Pmetrics software package for R. Sixteen patients (9 undergoing CVVH, 11 undergoing CVVHDF) and 20 sampling intervals were analyzed. A two-compartment linear model best described the data. Patient weight was the only covariate that was associated with drug clearance. The mean ± standard deviation parameter estimates were 25.2 ± 17.3 liters for the central volume, 0.89 ± 1.17 h(-1) for the rate constant for the drug distribution from the central to the peripheral compartment, 2.38 ± 6.60 h(-1) for the rate constant for the drug distribution from the peripheral to the central compartment, 4.45 ± 2.35 liters/h for hemodiafiltration clearance, and 4.69 ± 2.42 liters/h for hemofiltration clearance. Dosing simulations for amikacin supported the use of high dosing regimens (≥25 mg/kg) and extended intervals (36 to 48 h) for most patients when considering PK/pharmacodynamic (PD) targets of a maximum concentration in plasma (Cmax)/MIC ratio of ≥8 and a minimal concentration of ≤2.5 mg/liter at the end of the dosing interval. The mean clearance of amikacin was 1.8 ± 1.3 liters/h by CVVHDF and 1.3 ± 1 liters/h by CVVH. On the basis of simulations, a strategy of an extended-interval high loading dose of amikacin (25 mg/kg every 48 h) associated with therapeutic drug monitoring (TDM) should be the preferred approach for aminoglycoside treatment in critically ill patients receiving continuous renal replacement therapy (CRRT). (This study is a substudy of a trial registered at ClinicalTrials.gov under number NCT01403220.). Copyright © 2016, American Society

  4. The Concordance between Patients’ Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?

    Science.gov (United States)

    2015-01-01

    Introduction It is desirable for patients to play active roles in the choice of renal replacement therapy (RRT). Patient decision aid tools (PDAs) have been developed to allow the patients to choose the option best suited to their individual needs. Material and Methods An observational, prospective registry was conducted in 26 Spanish hospitals between September 2010 and May 2012. The results of the patients’ choice and the definitive RRT modality were registered through the progressive implementation of an Education Process (EP) with PDAs designed to help Chronic Kidney Disease (CKD) patients choose RRT. Results Patients included in this study: 1044. Of these, 569 patients used PDAs and had made a definitive choice by the end of registration. A total of 88.4% of patients chose dialysis [43% hemodialysis (HD) and 45% peritoneal dialysis (PD)] 3.2% preemptive living-donor transplant (TX), and 8.4% conservative treatment (CT). A total of 399 patients began RRT during this period. The distribution was 93.4% dialysis (53.6% HD; 40% PD), 1.3% preemptive TX and 5.3% CT. The patients who followed the EP changed their mind significantly less often [kappa value of 0.91 (95% CI, 0.86–0.95)] than those who did not follow it, despite starting unplanned treatment [kappa value of 0.85 (95% CI, 0.75–0.95]. A higher agreement between the final choice and a definitive treatment was achieved by the EP and planned patients [kappa value of 0.93 (95% CI, 0.89–0.98)]. Those who did not go through the EP had a much lower index of choosing PD and changed their decision more frequently when starting definitive treatment [kappa value of 0.73 (95% CI, 0.55–0.91)]. Conclusions Free choice, assisted by PDAs, leads to a 50/50 distribution of PD and HD choice and an increase in TX choice. The use of PDAs, even with an unplanned start, achieved a high level of concordance between the chosen and definitive modality. PMID:26466387

  5. Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting.

    Directory of Open Access Journals (Sweden)

    Belén Marrón

    Full Text Available Integrated Care Settings (ICS provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT, offering at least both types of dialysis.To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics.Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start.Modality information (80% of patients and renal education (87% were more frequent (p8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. "Optimal care," defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%.Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD.

  6. Renal replacement therapy for acute renal failure.

    Science.gov (United States)

    Macedo, E; Bouchard, J; Mehta, R L

    2009-09-01

    Renal replacement therapy became a common clinical tool to treat patients with severe acute kidney injury (AKI) since the 1960s. During this time dialytic options have expanded considerably; biocompatible membranes, bicarbonate dialysate and dialysis machines with volumetric ultrafiltration control have improved the treatment for acute kidney injury. Along with advances in methods of intermittent hemodialysis, continuous renal replacement therapies have gained widespread acceptance in the treatment of dialysis-requiring AKI. However, many of the fundamental aspects of the renal replacement treatment such as indication, timing of dialytic intervention, and choice of dialysis modality are still controversial and may influence AKI patient's outcomes. This review outlines current concepts in the use of dialysis techniques for AKI and suggests an approach for selecting the optimal method of renal replacement therapy.

  7. Drug Dosing During Continuous Renal Replacement Therapies

    OpenAIRE

    Thompson, A. Jill

    2008-01-01

    Continuous renal replacement therapies (CRRT) are used to manage fluid overload and/or renal failure. The continuous nature of the fluid and solute removal has less impact on hemodynamic variables in critically ill patients, making CRRT preferred over intermittent hemodialysis for some patients in the intensive care arena. The impact of CRRT on drug removal is variable depending on the CRRT modality, the ultrafiltrate and dialysate flow rates, the filter, and the patient's residual renal func...

  8. [Acute renal replacement therapy in pediatrics].

    Science.gov (United States)

    Gaillot, T; Ozanne, B; Bétrémieux, P; Tirel, O; Ecoffey, C

    2013-12-01

    In pediatric intensive care unit, the available modalities of acute renal replacement therapy include intermittent hemodialysis, peritoneal dialysis and continuous renal replacement therapies. No prospective studies have evaluated to date the effect of dialysis modality on the outcomes of children. The decision about dialysis modality should therefore be based on local expertise, resources available, and the patient's clinical status. Poor hemodynamic tolerance of intermittent hemodialysis is a common problem in critically ill patients. Moreover, many pediatric intensive care units are not equipped with dedicated water circuit. Peritoneal dialysis, a simple and inexpensive alternative, is the most widely available form of acute renal replacement therapy. However, its efficacy may be limited in critically ill patients. The use of continuous renal replacement therapy permits usually to reach a greater estimated dialysis dose, a better control of fluid balance, and additionally, to provide adequate nutrition. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  9. Renal replacement therapy in ICU

    Directory of Open Access Journals (Sweden)

    C Deepa

    2012-01-01

    Full Text Available Diagnosing and managing critically ill patients with renal dysfunction is a part of the daily routine of an intensivist. Acute kidney insufficiency substantially contributes to the morbidity and mortality of critically ill patients. Renal replacement therapy (RRT not only does play a significant role in the treatment of patients with renal failure, acute as well as chronic, but also has spread its domains to the treatment of many other disease conditions such as myaesthenia gravis, septic shock and acute on chronic liver failure. This article briefly outlines the role of renal replacement therapy in ICU.

  10. [Extracorporeal renal replacement therapies in acute renal failure].

    Science.gov (United States)

    Schaefer, R M; Barenbrock, M; Teschner, M; Bahner, U

    2000-05-15

    The most serious forms of acute renal failure (ARF) are nowadays encountered in the intensive care unit (ICU), where up to 25% of new patients are reported to develop ARF. Lethality rates may reach 50 to 90% when the ARF is part of a multiple organ dysfunction syndrome. A multitude of extracorporeal procedures have been introduced into intensive care medicine. Applied with adequate skills and experience, most of these techniques will suffice to replace excretory renal function. However, because of low efficacy arterio-venous procedures (CAVH and CAVHD) have been abandoned for the veno-venous, pump-driven techniques (CVVH and CVVHD). Up to now, there is no consensus whether continuous or intermittent renal replacement therapy is more advantageous. In many cases, oliguric patients with circulatory instability will be treated by CVVH, even though there is no prospective study to show that in terms of outcome continuous treatment is superior to intermittent hemodialysis. It is equally conceivable to treat such patients with daily, prolonged (intermittent) hemodialysis. Apparently, the dose of replacement therapy, be it continuous filtration (36 to 48 l/24 h) or intermittent hemodialysis (daily 3 to 4 h) with a target BUN of less than 50 mg/dl, is more important than the modality of treatment. Moreover, there is good evidence that the use of biocompatible membranes (no complement- or leukocyte activation) is preferable and that with high-volume hemofiltration bicarbonate-containing replacement fluids should be used. However, despite all the technical advances, we firmly believe that the skills and the experience of those physicians and nurses who actually perform renal replacement therapy in the ICU are more important than the modality of treatment applied.

  11. Renal replacement therapy in Europe

    DEFF Research Database (Denmark)

    Noordzij, Marlies; Kramer, Anneke; Abad Diez, José M

    2014-01-01

    BACKGROUND: This article provides a summary of the 2011 ERA-EDTA Registry Annual Report (available at www.era-edta-reg.org). METHODS: Data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) from national and regional renal registries in 30 countries in Europe and bordering the .......6-47.0], and on dialysis 39.3% (95% CI 39.2-39.4). The unadjusted 5-year patient survival after the first renal transplantation performed between 2002 and 2006 was 86.7% (95% CI 86.2-87.2) for kidneys from deceased donors and 94.3% (95% CI 93.6-95.0) for kidneys from living donors....

  12. Drug dosing during continuous renal replacement therapies.

    Science.gov (United States)

    Thompson, A Jill

    2008-04-01

    Continuous renal replacement therapies (CRRT) are used to manage fluid overload and/or renal failure. The continuous nature of the fluid and solute removal has less impact on hemodynamic variables in critically ill patients, making CRRT preferred over intermittent hemodialysis for some patients in the intensive care arena. The impact of CRRT on drug removal is variable depending on the CRRT modality, the ultrafiltrate and dialysate flow rates, the filter, and the patient's residual renal function; all of these may change from patient to patient or even in the same patient depending on the clinical status. However, CRRT modalities are generally more efficient than intermittent hemodialysis at drug removal, in some cases approximating or even exceeding normal renal function, resulting in a significant risk of subtherapeutic dosing if conventional hemodialysis dosing recommendations are followed. This annotated bibliography provides a summary of publications analyzing drug removal during CRRT, including CRRT settings and drug clearance values found in each study. Caution is warranted as findings from one study may not be generalizable to all patients due to the many factors that influence drug removal. Serum drug concentrations should be monitored when available, and patient clinical status is exceedingly important for following expected and unexpected responses to drug therapies. Reviews on general drug dosing calculations in CRRT are available elsewhere.

  13. Renal replacement therapy after cardiac surgery; renal function recovers

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Kandler, Kristian; Agerlin Windeløv, Nis

    2013-01-01

    To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy.......To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy....

  14. Renal replacement therapy in sepsis-induced acute renal failure

    Directory of Open Access Journals (Sweden)

    Rajapakse Senaka

    2009-01-01

    Full Text Available Acute renal failure (ARF is a common complication of sepsis and carries a high mortality. Renal replacement therapy (RRT during the acute stage is the mainstay of therapy. Va-rious modalities of RRT are available. Continuous RRT using convective methods are preferred in sepsis-induced ARF, especially in hemodynamically unstable patients, although clear evidence of benefit over intermittent hemodialysis is still not available. Peritoneal dialysis is clearly inferior, and is not recommended. Early initiation of RRT is probably advantageous, although the optimal timing of dialysis is yet unknown. Higher doses of RRT are more likely to be beneficial. Use of bio-compatible membranes and bicarbonate buffer in the dialysate are preferred. Anticoagulation during dialysis must be carefully adjusted and monitored.

  15. [Renal replacement therapy for refractory heart failure].

    Science.gov (United States)

    Schwenger, V; Remppis, A B

    2012-07-01

    After broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines, renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. This is even more important as renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest growing morbidities in western countries. Although peritoneal dialysis (PD) is frequently used in patients with CHF its role remains unclear. Acute chronic volume overload in refractory CHF is still an unresolved clinical problem. In patients with acute heart and renal failure with need of management in an intensive care unit, extracorporeal ultrafiltration or a dialysis modality should be preferred. In patients with chronic refractory CHF, volume overload and renal failure, peritoneal dialysis should be the therapy of choice. Due to the limited data available, treatment and outcome parameters should be recorded in the registry of the German Society of Nephrology (http://www.herz-niere.de).

  16. RENAL REPLACEMENT THERAPY FOR END-STAGE RENAL DISEASE PATIENTS IN RUSSIAN FEDERATION, 1998–2011 (Report of the Russian Registry of Renal Replacement Therapy

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    N. A. Tomilina

    2015-01-01

    Full Text Available The report of the Russian Renal Replacement Therapy Registry covers the period from the year 1998 to 2011 and represents data on the national, regional, and individual patient levels. We summarize information about epidemiology of treated end-stage renal disease in Russia, and describe in details incidence and prevalence for all modalities of renal replacement therapy. The article contains broad spectrum of data on quality of treatment indicators, waiting list, pharmacological treatment, mortality, and survival patterns in patients on hemodialysis, peritoneal dialysis and with functioning renal graft. 

  17. Drug dosing during continuous renal replacement therapies

    National Research Council Canada - National Science Library

    Thompson, A Jill

    2008-01-01

    ... in the intensive care arena. The impact of CRRT on drug removal is variable depending on the CRRT modality, the ultrafiltrate and dialysate flow rates, the filter, and the patient's residual renal function...

  18. RENAL REPLACEMENT THERAPY IN ACUTE KIDNEY FAILURE - AN OVERVIEW

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    Treesa P. Varghese

    2014-10-01

    Full Text Available Renal failure is the loss of renal function, either acute or chronic, that results in azotemia and syndrome of uremia. Acute renal failure, is also known as acute kidney injury (AKI, is defined as an abrupt (within 48 hours reduction in kidney function. The initial management of acute kidney failure involves treating the underlying cause, stopping nephrotoxic drugs and ensuring that the patient is euvolaemic with an adequate mean arterial blood pressure. However, no specific treatments have been shown to reverse the course AKF so Renal Replacement Therapy (RRT is the cornerstone of further management. RRT therapy can be administrated either intermittently or continuously. Multiple modalities of RRT are currently available. The purpose of this review is to familiarize different modalities of RRT for blood purification.

  19. CROSS-SECTIONAL IMAGING EVALUATION OF RENAL REPLACEMENT LIPOMATOSIS (RRL

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    Deb Kumar Boruah

    2016-06-01

    Full Text Available BACKGROUND Renal replacement lipomatosis is an uncommon benign entity where abundance of fibrofatty tissue proliferation occurs in renal sinus with further extension of proliferated fatty tissues into renal hilum, perinephric and periureteric spaces. It is usually associated with renal atrophy and marked renal parenchymal destruction. Aim of our study was cross-sectional imaging evaluation of Renal Replacement Lipomatosis (RRL. METHODS A hospital based cross-sectional retrospective study was conducted. The study group comprised of 16 patients presenting to the Departments of Radio-diagnosis, Surgery and Urology in a tertiary care hospital from May 2014 to April 2016. All patients were initially evaluated clinically and ultrasonographically followed by cross-sectional imaging modality like Computed Tomography (CT, Magnetic Resonance Imaging (MRI or both. RESULTS Out of 16 patients of renal replacement lipomatosis, 15 patients (93.8% had associated renal pelvic or ureteric calculus while 1 patient (6.2% had left para-aortic mass without associated calculus. Out of fifteen patients of calculus related RRL, 8 patients (53.3% had calculus size more than 40 mm, followed by 4 patients (26.7% who had size from 20 to 40 mm and 3 patients (20% had size less than 20 mm. The mean CT HU value of calculus was 1334±84.5 in our study. Three patients (18.8% had only renal hilar fatty excessive deposition, 1 patient (6.2% had renal hilar and perinephric space fat depositions, 3 patients (18.8% had renal hilar, perinephric and periureteric spaces depositions and 9 patients (56.2% had renal hilar and periureteric excessive fatty depositions. Delayed renal functioning was noted in 9 patients (56%, followed by non-functioning in 5 patients (31.2% and 2 patients (12.5% had normally functioning kidneys. CONCLUSION Cross-sectional imaging like CT and MRI scan helps in diagnosing RRL and proper delineation of extensions of excessive fatty tissue proliferation.

  20. Acute Renal Replacement Therapy in Pediatrics

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    Rajit K. Basu

    2011-01-01

    Full Text Available Acute kidney injury (AKI independently increases morbidity and mortality in children admitted to the hospital. Renal replacement therapy (RRT is an essential therapy in the setting of AKI and fluid overload. The decision to initiate RRT is complex and often complicated by concerns related to patient hemodynamic and thermodynamic instability. The choice of which RRT modality to use depends on numerous criteria that are both patient and treatment center specific. Surprisingly, despite decades of use, no randomized, controlled trial study involving RRT in pediatrics has been performed. Because of these factors, clear-cut consensus is lacking regarding key questions surrounding RRT delivery. In this paper, we will summarize existing data concerning RRT use in children. We discuss the major modalities and the data-driven specifics of each, followed by controversies in RRT. As no standard of care is in widespread use for RRT in AKI or in multiorgan disease, we conclude in this paper that prospective studies of RRT are needed to identify best practice guidelines.

  1. Renal replacement therapy in Europe

    DEFF Research Database (Denmark)

    Pippias, Maria; Stel, Vianda S; Abad Diez, José Maria

    2015-01-01

    BACKGROUND: This article summarizes the 2012 European Renal Association-European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years). METHODS: Data provided by 45 national or regional renal r...

  2. [Treatment of acute renal failure--concepts and controversies. 2. Extracorporeal renal replacement and peritoneal dialysis].

    Science.gov (United States)

    Gabriel, A; Müller, E; Tarnow, J

    2001-04-01

    Therapy of prolonged acute renal failure regularly requires a renal replacement therapy. This can be achieved by different extracorporal renal replacement therapies (ERRT) or by peritoneal dialysis. ERRT are classified according to the physical principle underlying toxin elimination as hemodialysis (diffusion) and hemofiltration (convection). Another classification refers to intermittent or continuous application modes. Biocompatibility of membranes is judged according to their activation of the complement system. Prospective randomized studies did not consolidate the assumptions about the benefit of particular modalities proposed on theoretical foundations. Mortality, duration and complication rates of acute renal failure are not significantly decreased by use of biocompatible membranes. Continuous modalities are not generally preferable but optimize treatment in hemodynamically unstable patients, in whom they endorse fluid balancing and maintenance of sufficient arterial blood pressure. The use of demanding hemofiltration techniques for cytokine removal should be limited to clinical studies. The effects of ERRT-"intensity" and the best timing for initiation of ERRT have not been evaluated sufficiently. The choice of the ERRT modality is subject to clinical judgement (criterion: hemodynamic situation), practical aspects (criteria: availability of equipment and handling experience), and costs. Prior to their general use new and expensive technical modalities and membrane types should be thoroughly evaluated in studies with regard to outcome-related aspects such as patient survival and preservation of renal function.

  3. Renal replacement therapy in yemen.

    Science.gov (United States)

    Sheiban, A K; Yehia, A; Mohamed, Y A; Hajar, A R

    1996-01-01

    In this report we present the current status of dialysis and transplantation in Yemen. The reported incidence of end stage renal disease (ESRD) in one region of Yemen was estimated as 385 per million population (PMP) per year. The total population of Yemen is also estimated as 16,000,000. Peritoneal dialysis was started in 1980, while hemodialysis was started in 1981. At present there are around 36 hemodialysis machines distributed in the large cities of Yemen. Intermittent peritoneal dialysis is commonly used; however, continuous ambulatory peritoneal dialysis has been out of practice since 1992. Renal transplantation has not yet been started in Yemen; however, at present there are 327 transplant patients being followed up in it. The majority of patients had their grafts from living non related donors abroad. In our experience, such transplantations were associated with high morbidity and mortality, in addition to acquisition of serious, potentially lethal extra-renal medical problems. We believe that there is a wide shortage of renal services in Yemen. Establishing a National Kidney Foundation to organize these services may be helpful.

  4. Renal Replacement Therapy in Austere Environments

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    Christina M. Yuan

    2011-01-01

    Full Text Available Myoglobinuric renal failure is the classically described acute renal event occurring in disaster environments—commonly after an earthquake—which most tests the ingenuity and flexibility of local and regional nephrology resources. In recent decades, several nephrology organizations have developed response teams and planning protocols to address disaster events, largely focusing on patients at risk for, or with, acute kidney injury (AKI. In this paper we briefly review the epidemiology and outcomes of patients with dialysis-requiring AKI after such events, while providing greater focus on the management of the end-stage renal disease population after a disaster which incapacitates a pre-existing nephrologic infrastructure (if it existed at all. “Austere” dialysis, as such, is defined as the provision of renal replacement therapy in any setting in which traditional, first-world therapies and resources are limited, incapacitated, or nonexistent.

  5. Renal replacement therapies after abdominal aortic aneurysm repair--a review.

    Science.gov (United States)

    Hudorović, Narcis; Lovricević, Ivo; Brkić, Petar; Ahel, Zaky; Vicić-Hudorović, Visnja

    2011-09-01

    The objective of this review is to assess the incidence of postoperative acute renal failure that necessitates the application of hemofiltration and to determine the factors that influence the outcome in patients undergoing surgical repair of abdominal aortic aneurysm. In addition, the review aims to assess the outcomes of postoperative early hemofiltration as compared to late intensive hemofiltration. Different forms of renal replacement therapies for use in abdominal aortic aneurysm surgery patients are discussed. Electronic literature searches were performed using Pubmed, Medline, Embase, Sumsearch, Cinahil, The Cochrane Central Register of Controlled Trials and Excerpta Medica. The search identified 419 potentially eligible studies, of which 119 were excluded based on the title and abstract. Of the remaining 300 studies, full articles were collected and re-evaluated. Forty-five articles satisfied our inclusion criteria, of which only 12 were of the IA Level of evidence. The search results indicated that the underlying disease, its severity and stage, the etiology of acute renal failure, clinical and hemodynamic status of the patient, the resources available, and different costs of therapy might all influence the choice of the renal replacement therapy strategy. However, clear guidelines on renal replacement therapy duration are still lacking. Moreover, it is not known whether in acute renal failure patients undergoing abdominal aortic aneurysm surgery, renal replacement therapy modalities can eliminate significant amounts of clinically relevant inflammatory mediators. This review gives current information available in the literature on the possible mechanisms underlying acute renal failure and recent developments in continuous renal replacement treatment modalities.

  6. Renal Replacement Therapy [version 1; referees: 4 approved

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    Zaccaria Ricci

    2016-01-01

    Full Text Available During the last few years, due to medical and surgical evolution, patients with increasingly severe diseases causing multiorgan dysfunction are frequently admitted to intensive care units. Therapeutic options, when organ failure occurs, are frequently nonspecific and mostly directed towards supporting vital function. In these scenarios, the kidneys are almost always involved and, therefore, renal replacement therapies have become a common routine practice in critically ill patients with acute kidney injury. Recent technological improvement has led to the production of safe, versatile and efficient dialysis machines. In addition, emerging evidence may allow better individualization of treatment with tailored prescription depending on the patients’ clinical picture (e.g. sepsis, fluid overload, pediatric. The aim of the present review is to give a general overview of current practice in renal replacement therapies for critically ill patients. The main clinical aspects, including dose prescription, modality of dialysis delivery, anticoagulation strategies and timing will be addressed. In addition, some technical issues on physical principles governing blood purification, filters characteristics, and vascular access, will be covered. Finally, a section on current standard nomenclature of renal replacement therapy is devoted to clarify the “Tower of Babel” of critical care nephrology.

  7. Modeling Outcome of Patients on Renal Replacement Therapy

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina)

    2008-01-01

    textabstractThe incidence of end-stage renal disease is increasing and therefore, the number of patients requiring renal replacement therapy (RRT), renal dialysis or renal transplantation (RTx), has been rising. The various forms of RRT are associated with differences in survival and quality of life

  8. Renal replacement therapy in Korea, 2012

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    Dong Chan Jin

    2014-03-01

    Full Text Available The Korean Society of Nephrology (KSN launched the official end-stage renal disease (ESRD patient registry in 1985, and an Internet online registry program was opened in 2001 and revised in 2013. The ESRD Registry Committee of KSN has collected data on dialysis therapy in Korea through the online registry program in the KSN Internet website. The status of renal replacement therapy in Korea at the end of 2012 is described in the following. The total number of ESRD patients was 70,211 at the end of 2012, which included 48,531 hemodialysis (HD patients, 7,552 peritoneal dialysis (PD patients, and 14,128 functioning kidney transplant (KT patients. The prevalence of ESRD was 1,353.3 patients per million population (PMP, and the distribution of renal replacement therapy among ESRD patients was as follows: HD, 69.1%; PD, 10.8%; and KT, 20.2%. The number of new ESRD patients in 2012 was 11,742 (HD, 8,811; PD, 923; and KT, 1,738; the incidence rate was 221.1 PMP. The primary causes of ESRD were diabetic nephropathy (50.6%, hypertensive nephrosclerosis (18.5%, and chronic glomerulonephritis (18.1%. The mean urea reduction ratio was 67.9% in male and 74.1% in female HD patients. The mean Kt/V was 1.382 in male and 1.652 in female HD patients. The 5-year survival rates of male and female dialysis patients were 70.6% and 73.5%, respectively.

  9. [Pharmacokinetics of antibiotics in continuous renal replacement therapies (CRRT)].

    Science.gov (United States)

    Morabito, Santo; Pistolesi, Valentina; Maggiore, Umberto; Fiaccadori, Enrico; Pierucci, Alessandro

    2012-01-01

    In the critically ill patient, acute kidney injury (AKI) is frequently associated with infective complications requiring appropriate antimicrobial treatment. AKI and multiple organ dysfunction syndrome can affect the pharmacokinetic parameters of many drugs. Furthermore, the start of renal replacement therapy (RRT) is an additional variable to be taken into consideration to avoid inappropriate antimicrobial therapy. Continuous renal replacement therapies (CRRT) are widely adopted in the intensive care unit (ICU) and antibiotics that are significantly eliminated by the kidney are likely to be removed during RRT. Generally, drug-dosing adjustments are required if the extracorporeal clearance accounts for more than 25-30% of the total body clearance. The molecular weight cutoffs of the more widely used membranes are much higher than the molecular weight of most drugs. Therefore, molecular size will not be a limitation for the removal of the unbound fraction of the antibiotics most commonly used in ICU patients. However, CRRTs are still not standardized and the impact of RRT on plasma drug concentrations can be substantially different depending on the CRRT modality (diffusive, convective or both), membrane characteristics and delivered dialysis dose. In any case, drug-dosing adjustments should be based on the knowledge of the pharmacokinetic and pharmacodynamic properties of the different classes of antimicrobials, taking into account that high extracorporeal clearances could lead to drug underexposure in clinical conditions where appropriate antibiotic treatment is essential.

  10. Trends in Renal Replacement Therapy in Turkey, 1996-2008

    NARCIS (Netherlands)

    G. Suleymanlar; K. Serdengecti; M.R. Altiparmak; K. Jager; N. Seyahi; E. Erek

    2011-01-01

    Background: National renal registry studies providing data for incidence, prevalence, and characteristics of end-stage renal disease and renal replacement therapy (RRT) serve as a basis to determine national strategies for the prevention and treatment of these diseases and identify new areas for spe

  11. Antimicrobial dosing in acute renal replacement.

    Science.gov (United States)

    Fissell, William H

    2013-01-01

    Acute kidney injury (AKI) is a common problem in hospitalized patients and is associated with significant morbidity and mortality. Two large trials showed no benefit from increased doses of renal replacement therapy (RRT) despite previous clinical data suggesting that increased clearance from RRT has beneficial effects. Since infection is the leading cause of death in AKI, my group and others hypothesized that increased RRT antibiotic clearance might create a competing morbidity. The data from my group, as well as those of other groups, show that many patients are underdosed when routine "1 size fits all" antibiotic dosing is used in patients with AKI receiving continuous RRT (CRRT). Here, concepts of drug distribution and clearance in AKI are briefly discussed and then 1 antibiotic (piperacillin) is discussed in depth to illustrate the challenges in applying the medical literature to clinical practice. The fact that published data on drug dosing in AKI and dialysis reflect the evolution of practice patterns and often do not apply to present prescribing habits is also discussed. A more general approach to drug dosing facilitates situation-specific prescribing by the nephrologist and critical care specialist. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  12. Drug dosing during continuous renal replacement therapy.

    Science.gov (United States)

    Churchwell, Mariann D; Mueller, Bruce A

    2009-01-01

    Continuous renal replacement therapy (CRRT) has given clinicians an important option in the care of critically ill patients. The slow and continuous dialysate and ultrafiltrate flow rates that are employed with CRRT can yield drug clearances similar to an analogous glomerular filtration rate of the native kidneys. Advantages such as superior volume control, excellent metabolic control, and hemodynamic tolerance by critically ill patients are well documented, but an understanding of drug dosing for CRRT is still a bit of a mystery. Although some pharmaceutical companies have dedicated postmarket research in this direction, many pharmaceutical companies have chosen not to pursue this information as it is not mandated and represents a relatively small part of their market. This lack of valuable information has created many challenges in the care of the critically ill patient as intermittent hemodialysis drug dosing recommendations cannot be extrapolated to CRRT. This drug dosing review will highlight factors that clinicians should consider when determining a pharmacotherapy regimen for a patient receiving CRRT.

  13. Cost analysis of the Spanish renal replacement therapy programme.

    Science.gov (United States)

    Villa, Guillermo; Rodríguez-Carmona, Ana; Fernández-Ortiz, Lucía; Cuervo, Jesús; Rebollo, Pablo; Otero, Alfonso; Arrieta, Javier

    2011-11-01

    A cost analysis of the Spanish Renal Replacement Therapy (RRT) programme in the year 2010, for end-stage renal disease (ESRD) patients, was performed from the perspective of the Public Administration. The costs associated with each RRT modality [hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (Tx)] were analysed. The Spanish ESRD incidence and prevalence figures in the year 2010 were forecasted in order to enable the calculation of an aggregate cost for each modality. Costs were mainly computed based on a review of the existing literature and of the Official Bulletins of the Spanish Autonomous Communities. Data from Oblikue Consulting eSalud health care costs database and from several Spanish public sources were also employed. In the year 2010, the forecasted incidence figures for HD, PD and Tx were 5409, 822 and 2317 patients, respectively. The forecasted prevalence figures were 22,582, 2420 and 24,761 patients, respectively. The average annual per-patient costs (incidence and prevalence) were €2651 and €37,968 (HD), €1808 and €25,826 (PD) and €38,313 and €6283 (Tx). Indirect costs amounted to €8929 (HD), €7429 (PD) and €5483 (Tx). The economic impact of the Spanish RRT programme on the Public Administration budget was estimated at ~€1829 million (indirect costs included): €1327 (HD), €109 (PD) and €393 (Tx) million. HD accounted for >70% of the aggregate costs of the Spanish RRT programme in 2010. From a costs minimization perspective, it would be preferable if the number of incident and prevalent patients in PD were increased.

  14. Single-tooth replacement: factors affecting different prosthetic treatment modalities

    Directory of Open Access Journals (Sweden)

    Al-Quran Firas A

    2011-12-01

    Full Text Available Abstract Background The choice between several treatment options for replacing a single missing tooth is influenced by clinical, dentist- and patient-immanent factors. This study aimed to determine the patient factors that would affect the treatment decision to replace a single missing tooth and to assess the satisfaction with several options. Method 200 volunteers involved (121 females and 79 males divided into four groups, Group A: consisted of patients with conventional fixed partial dentures or patients with resin bonded fixed partial dentures. Group B: consisted of patients who received removable partial dentures while Group C: consisted of patients who received a single implant supported crown, and a control group D: consisted of patients who received no treatment. Data were collected using a questionnaire. Results The highest percentage of males within groups (58% was within the removable prostheses category. The majority of the subjects in the study reported that the main reason for replacing a missing tooth was for esthetic and function. Most important factor affecting the choice between treatment modalities was damaging the neighboring teeth. Pain, post operative sensitivity and dental phobia were important factors in choosing the prosthesis type and affected the control group patients not to have any treatment. The highest satisfaction percentage among groups studied was recorded for dental implants then FPD groups, while the least percentage were in both the control and RPD groups, for all aspects of function, esthetic and speech efficiency. Conclusions The final choice between FPD, RPD and implant depended on several factors which affected the decision making; among these is cost and patients' awareness of the different treatment options.

  15. Nursing procedures during continuous renal replacement therapies: a national survey

    OpenAIRE

    Ricci, Zaccaria; Benelli, Sonia; Barbarigo, Fabio; Cocozza, Giulia; Pettinelli, Noemi; Di Luca, Emanuela; Mettifogo, Mariangela; Toniolo, Andrea; Ronco, Claudio

    2015-01-01

    Introduction The current role of nurses in the management of critically ill patients needing continuous renal replacement therapies is clearly fundamental. The care of these complex patients is typically shared by critical care and dialysis nurses: their precise duties may vary from country to country. Methods To clarify this issue we conducted a national-level survey at a recent Italian course on nursing practices during continuous renal replacement therapies. Results A total of 119 question...

  16. Demographics of paediatric renal replacement therapy in Europe

    DEFF Research Database (Denmark)

    Chesnaye, Nicholas; Bonthuis, Marjolein; Schaefer, Franz;

    2014-01-01

    BACKGROUND: The ESPN/ERA-EDTA Registry collects data on European children with end-stage renal disease receiving renal replacement therapy (RRT) who are listed on national and regional renal registries in Europe. In this paper we report on the analysis of demographic data collected from 2009...... to 2011. METHODS: Data on primary renal disease, incidence, prevalence, 4-year survival, transplantation rate and causes of death in paediatric patients receiving RRT were extracted from the ESPN/ERA-EDTA Registry for 37 European countries. RESULTS: The incidence of RRT in paediatric patients in Europe...

  17. Continuous Renal Replacement Therapy for Severe Obstetric Sepsis

    Directory of Open Access Journals (Sweden)

    D. L. Shukevich

    2010-01-01

    Full Text Available Objective: to improve the results of treatment for severe obstetric sepsis by pathogenetically founded continuous renal replacement therapies as extracorporeal homeostatic correction. Subjects and methods. Forty-two women with severe abdominal sepsis were divided into 3 groups: 1 14 women with severe extragenital abdominal sepsis who received standard intensive care (a control group; 2 12 women with severe obstetric sepsis who had standard intensive care (a study group; 3 16 with severe obstetric sepsis who had the standard intensive care supplemented with continuous renal replacement therapy (an intervention group. Results. In Group 2, endogenous intoxication and multiple organ dysfunction were controlled later than in Group 1, mortality rates being 41.7 and 7.1%, respectively. Clinical laboratory differences were due to gestosis recorded in 100% of the patients with severe obstetric sepsis. When continuous renal replacement therapy was incorporated into the complex therapy of severe obstetric sepsis, there was a prompter regression of endogenous intoxication and multiple organ dysfunction, mortality was decreased by an average of 35% as compared with that during standard therapy. Conclusion. The inclusion of continuous renal replacement therapy into the complex treatment program for severe obstetric sepsis made it possible to reduce control time _ for endogenous intoxication and multiple organ dysfunction and to decrease mortality by an average of 35% as compared with that during standard intensive care. Key words: obstetric sepsis, abdominal sepsis, gestosis, endogenous intoxication, multiple organ dysfunction, renal replacement therapy.

  18. Future of the Renal Biopsy: Time to Change the Conventional Modality Using Nanotechnology

    Science.gov (United States)

    Khosroshahi, Hamid Tayebi; Sarbaz, Yashar; Shakeri Bavil, Abolhassan

    2017-01-01

    At the present time, imaging guided renal biopsy is used to provide diagnoses in most types of primary and secondary renal diseases. It has been claimed that renal biopsy can provide a link between diagnosis of renal disease and its pathological conditions. However, sometimes there is a considerable mismatch between patient renal outcome and pathological findings in renal biopsy. This is the time to address some new diagnostic methods to resolve the insufficiency of conventional percutaneous guided renal biopsy. Nanotechnology is still in its infancy in renal imaging; however, it seems that it is the next step in renal biopsy, providing solutions to the limitations of conventional modalities.

  19. Renal function after elective total hip replacement

    DEFF Research Database (Denmark)

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

    2016-01-01

    and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...... ). Results - 3,416 patients were included (2,064 females (60%)). AKI (according to KDIGO criteria) was seen in 75 patients (2.2%, 95% CI: 1.7-2.7) in the course of primary total hip replacement. Of these, 26 had pre-existing CKD of class 3-5. Pre-existing CKD of class 3-5, indicating moderately to severely...

  20. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: part 2: renal replacement therapy.

    Science.gov (United States)

    Jörres, Achim; John, Stefan; Lewington, Andrew; ter Wee, Pieter M; Vanholder, Raymond; Van Biesen, Wim; Tattersall, James

    2013-12-01

    This paper provides an endorsement of the KDIGO guideline on acute kidney injury; more specifically, on the part that concerns renal replacement therapy. New evidence that has emerged since the publication of the KDIGO guideline was taken into account, and the guideline is commented on from a European perspective. Advice is given on when to start and stop renal replacement therapy in acute kidney injury; which modalities should be preferentially be applied, and in which conditions; how to gain access to circulation; how to measure adequacy; and which dose can be recommended.

  1. High Phenobarbital Clearance During Continuous Renal Replacement Therapy

    Science.gov (United States)

    Rosenborg, Staffan; Saraste, Lars; Wide, Katarina

    2014-01-01

    Abstract Phenobarbital is an old antiepileptic drug used in severe epilepsy. Despite this, little is written about the need for dose adjustments in renal replacement therapy. Most sources recommend a moderately increased dose guided by therapeutic drug monitoring. A 14 year old boy with nonketotic hyperglycinemia, a rare inborn error of metabolism, characterized by high levels of glycine, epilepsy, spasticity, and cognitive impairment, was admitted to the emergency department with respiratory failure after a few days of fever and cough. The boy was unconscious at admittance and had acute renal and hepatic failure. Due to the acute respiratory infection, hypoxic hepatic and renal failure occurred and the patient had a status epilepticus. The patient was intubated and mechanically ventilated. Continuous renal replacement therapy was initiated. Despite increased phenobarbital doses, therapeutic levels were not reached until the dose was increased to 500 mg twice daily. Therapeutic drug monitoring was performed in plasma and dialysate. Calculations revealed that phenobarbital was almost freely dialyzed. Correct dosing of drugs in patients on renal replacement therapy may need a multidisciplinary approach and guidance by therapeutic drug monitoring. PMID:25101986

  2. Renal replacement lipomatosis and xanthogranulomatous pyelonephritis: differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Romero, Frederico R. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil); Pilati, Roberto; Brenny Filho, Thadeu; Caboclo, Maria Fernanda Sales Ferreira [Hospital Sao Vicente de Curitiba, PR (Brazil); Silva, Antonio de Padua Gomes [Centro de Citopatologia Parana Ltda. (Citopar), Curitiba, PR (Brazil); Cravo, Marco Aurelio [Laboratorio de Patologia e Citologia (Consulpat), Curitiba, PR (Brazil)

    2011-05-15

    Renal replacement lipomatosis (RRL) is a relatively uncommon entity, although misdiagnosis - mainly with xanthogranulomatous pyelonephritis (XGP) - due to lack of awareness by urologists, radiologists, and pathologists may be responsible for underreporting. We illustrate a case of RRL that was initially misdiagnosed as XGP, and compare it with a classic case of XGP, underscoring the similarities and the differences between them. (author)

  3. Iodinated contrast media and the role of renal replacement therapy.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2011-05-01

    Iodinated contrast media are among the most commonly used pharmacologic agents in medicine. Although generally highly safe, iodinated contrast media are associated with several adverse effects, most significantly the risk of acute kidney injury, particularly in patients with underlying renal dysfunction. By virtue of their pharmacokinetic characteristics, these contrast agents are efficiently cleared by hemodialysis and to a lesser extent, hemofiltration. This has led to research into the capacity for renal replacement therapies to prevent certain adverse effects of iodinated contrast. This review examines the molecular and pharmacokinetic characteristics of iodinated contrast media and critically analyzes data from past studies on the role of renal replacement therapy to prevent adverse effects of these diagnostic agents. Published by Elsevier Inc.

  4. Renal replacement therapy in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Chacko Jose

    2008-01-01

    Full Text Available Acute renal failure is a frequent complication in critically ill patients that carries with it considerable morbidity and mortality. The management of renal failure in patients with multi-organ failure is different from that of renal failure that presents as a single organ failure. Intermittent haemodialysis, done in the conventional manner may not be tolerated by most critically ill patients. Continuous renal replacement therapy is physiologically superior; however, there is lack of strong evidence to prove a clinical benefit. Hybrid therapies that combine the benefits of intermittent haemodialysis and continuous therapies have emerged in the past few years. These are simpler to carry out, provide more flexibility and may be cost effective and need to be studied in a systematic manner.

  5. Possible removal of topiramate by continuous renal replacement therapy.

    Science.gov (United States)

    Browning, Linda; Parker, Dennis; Liu-DeRyke, Xi; Shah, Aashit; Coplin, William M; Rhoney, Denise H

    2010-01-15

    Topiramate is primarily renally eliminated and requires dosage adjustment based upon renal function. While there is data to suggest drug removal during intermittent hemodialysis (IHD), little is known regarding its clearance and dosing during continuous renal replacement therapy (CRRT). We describe a 59-year-old man with refractory status epilepticus who was started on continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure while receiving topiramate with a series of serum concentrations to assess for removal during CVVHDF. Our data suggest clinically important amounts of topiramate are removed by CRRT, and higher topiramate dosage may be needed for these patients instead of the current recommended 50% of normal dosage. Unfortunately, there is no antiepileptic drug dosing recommendation when used during CRRT due to the paucity of data. This case highlights a need for research evaluating the effect of CRRT on AED elimination in order to optimize therapy for seizure control.

  6. Renal replacement therapy in Latin American end-stage renal disease.

    Science.gov (United States)

    Rosa-Diez, Guillermo; Gonzalez-Bedat, Maria; Pecoits-Filho, Roberto; Marinovich, Sergio; Fernandez, Sdenka; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta-Miranda, Susana; Gomez, Rafael; Cerdas-Calderon, Manuel; Almaguer-Lopez, Miguel; Freire, Nelly; Leiva-Merino, Ricardo; Rodriguez, Gaspar; Luna-Guerra, Jorge; Bochicchio, Tomasso; Garcia-Garcia, Guillermo; Cano, Nuria; Iron, Norman; Cuero, Cesar; Cuevas, Dario; Tapia, Carlos; Cangiano, Jose; Rodriguez, Sandra; Gonzalez, Haydee; Duro-Garcia, Valter

    2014-08-01

    The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r(2) 0.86; P global incidence rate correlated significantly only with GNI (r(2) 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the

  7. Renal replacement therapy in Latin American end-stage renal disease

    Science.gov (United States)

    Rosa-Diez, Guillermo; Gonzalez-Bedat, Maria; Pecoits-Filho, Roberto; Marinovich, Sergio; Fernandez, Sdenka; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta-Miranda, Susana; Gomez, Rafael; Cerdas-Calderon, Manuel; Almaguer-Lopez, Miguel; Freire, Nelly; Leiva-Merino, Ricardo; Rodriguez, Gaspar; Luna-Guerra, Jorge; Bochicchio, Tomasso; Garcia-Garcia, Guillermo; Cano, Nuria; Iron, Norman; Cuero, Cesar; Cuevas, Dario; Tapia, Carlos; Cangiano, Jose; Rodriguez, Sandra; Gonzalez, Haydee; Duro-Garcia, Valter

    2014-01-01

    The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The

  8. Risk factors for renal dysfunction after total hip joint replacement

    DEFF Research Database (Denmark)

    Hassan, Basim Kamil; Sahlström, Arne; Dessau, Ram Benny Christian

    2015-01-01

    BACKGROUND AND PURPOSE OF THE STUDY: Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surgery......, hypertension, general anesthesia, high ASA scores, low intra-operative systolic BP, and prophylactic dicloxacillin as significant risk factors. Low baseline systolic BP, low baseline diastolic blood pressure, and hip fracture diagnosis were independent risk factors for postoperative increase in serum...... creatinine. Smoking, diabetes mellitus, high BMI, gender, and duration of surgery were not identified as significant risk factors....

  9. [Renal replacement therapy by hemodialysis in Constantine (Algeria)].

    Science.gov (United States)

    Bouhabel, Abdelouahab; Laib, Zoheir; Hannache, Kamel; Aberkane, Abdelhamid

    2014-02-01

    End-stage renal failure is considered a public heath problem that constitutes a heavy cost on communities worldwide. To be able to plan the treatment of this pathology, we must have reliable and updated information through health network which represents the best mean for planning and reflexion locally and nationwide. The aim of our study was to answer to this need through a local registry of renal replacement therapy and nephrology network that we have for the first time an inventory of this pathology in an Algerian town (Constantine), and in this article we present the first results concerning patients under chronic hemodialysis.

  10. Can contrast-enhanced renal MR angiography replace conventional angiography in preoperative evaluation of living renal donors?

    Directory of Open Access Journals (Sweden)

    Abdelhady Taha Emam

    2011-01-01

    Full Text Available The aim of the study was to detect if gadolinium-enhanced renal magnetic reso-nance angiography (MRA can replace conventional angiography in imaging vascular anatomy in potential living renal donors and compare with surgical findings. MR imaging (MRI and breath-hold three-dimensional gadolinium-enhanced MRA of kidneys were done for 60 conse-cutive patients for whom successful nephrectomy was done. MRA findings were compared with the findings of nephrectomy. MRI and MRA identified 28 out of 60 patients with normal arterial and venous anatomy, and concordance was found at surgery in 27 of these patients. Vascular anomalies were depicted on MRI in 32 patients, with concordance at surgery in 27 patients. Re-garding arterial anomalies, the MRA had a sensitivity of 89.3%, a specificity of 94.0% and an accuracy of 90.8%. For venous anomalies, the sensitivity was 98.5%, specificity was 100% and accuracy was 98.6%. In conclusion, gadolinium-enhanced MRA of the kidneys can replace con-ventional angiography as a safe and accurate modality for the assessment of potential living renal donors.

  11. Diverse modalities of gingival replacement: A report of three cases

    Directory of Open Access Journals (Sweden)

    Dileep N Vinnakota

    2012-01-01

    Full Text Available Gingival replacement is often a component of comprehensive prosthodontics. Gingival prostheses may be fixed or removable. It can be made from acrylics, composite resins, silicones or porcelain-based materials.This paper describes different clinical situations in which three types of gingival prostheses, removable acrylic veneer with melanin pigmentation, fixed ceramic veneer and flexible nylon based veneer, were used effectively.

  12. Current practice in continuous renal replacement therapy: An epidemiological multicenter study.

    Science.gov (United States)

    Tomasa Irriguible, T M; Sabater Riera, J; Poch López de Briñas, E; Fort Ros, J; Lloret Cora, M J; Roca Antònio, J; Navas Pérez, A; Ortiz Ballujera, P; Servià Goixart, L; González de Molina Ortiz, F J; Rovira Anglès, C; Rodríguez López, M; Roglan Piqueras, A

    2017-05-01

    The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. A total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. Current practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. A population approach to renal replacement therapy epidemiology: lessons from the EVEREST study.

    Science.gov (United States)

    Caskey, Fergus J; Jager, Kitty J

    2014-08-01

    The marked variation that exists in renal replacement therapy (RRT) epidemiology between countries and within countries requires careful systematic examination if the root causes are to be understood. While individual patient-level studies are undoubtedly important, there is a complementary role for more population-level, area-based studies--an aetiological approach. The EVEREST Study adopted such an approach, bringing RRT incidence rates, survival and modality mix together with macroeconomic factors, general population factors and renal service organizational factors for up to 46 countries. This review considers the background to EVEREST, its key results and then the main methodological lessons and their potential application to ongoing work. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  14. Pharmacokinetics and antimicrobial dosing adjustment in critically ill patients during continuous renal replacement therapy.

    Science.gov (United States)

    Kuang, D; Verbine, A; Ronco, C

    2007-05-01

    Appropriate antimicrobial therapy poses one of the greatest challenges during the management of a septic patient in the intensive care unit (ICU). Acute renal failure (ARF) is a common complication of sepsis and often occurs as a component of multiple organ dysfunction syndrome. Continuous renal replacement therapy (CRRT) is increasingly used as an effective extracorporeal blood purification therapy in this critically ill patient population. Available data demonstrate that sepsis, ARF and different modalities of CRRT may have profound effects on the pharmacokinetics and pharmacodynamics of various antimicrobial agents used in the ICU. Guidelines for antimicrobial prescription which will fit the individual patient undergoing a particular method of treatment are still unavailable. Understanding the principles of drug removal by CRRT and pharmacokinetics of various agents can help to modify the drug dosage and dosing intervals for individualized therapy. Meanwhile, monitoring the drug serum concentration is still mandatory whenever clinically feasible.

  15. [Drugs dosing in intensive care unit during continuous renal replacement therapy].

    Science.gov (United States)

    Bourquin, Vincent; Ponte, Belén; Saudan, Patrick; Martin, Pierre-Yves

    2009-11-01

    Drug dosing in the intensive care unit can be challenging. Acute kidney injury (AKI) is a common complication of sepsis and a part of multiple organ dysfunction syndrome. Continuous renal replacement therapy (CRRT) is increasingly used as dialysis therapy in this critically ill population. Available data demonstrate that sepsis, AKI and different modalities of CRRT can profoundly change drugs pharmacokinetic. The severity of these changes depends on molecules characteristics (volume of distribution, plasma protein binding, molecular weight, plasma half-life, plasma clearance), patient itself (volemia, residual renal function, tissue perfusion, hepatic dysfunction) and modality of CRRT (diffusion, convection, adsorption). There are no available recommendations to adapt drug dosing in a given critically ill patient with a given modality of CRRT. It is necessary to fully understand the different methods of CRRT and drug pharmacokinetic to prescribe the appropriate dose and to avoid under or potentially toxic overdosing. Monitoring the plasma level of drug - when available - can establish a relation between the blood concentration and its effect; thus, facilitating drug dosing.

  16. The optimal hormonal replacement modality selection for multiple organ procurement from brain-dead organ donors

    Directory of Open Access Journals (Sweden)

    Mi Z

    2014-12-01

    Full Text Available Zhibao Mi,1 Dimitri Novitzky,2 Joseph F Collins,1 David KC Cooper3 1Cooperative Studies Program Coordinating Center, VA Maryland Health Care Systems, Perry Point, MD, USA; 2Department of Cardiothoracic Surgery, University of South Florida, Tampa, FL, USA; 3Thomas E Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA Abstract: The management of brain-dead organ donors is complex. The use of inotropic agents and replacement of depleted hormones (hormonal replacement therapy is crucial for successful multiple organ procurement, yet the optimal hormonal replacement has not been identified, and the statistical adjustment to determine the best selection is not trivial. Traditional pair-wise comparisons between every pair of treatments, and multiple comparisons to all (MCA, are statistically conservative. Hsu’s multiple comparisons with the best (MCB – adapted from the Dunnett’s multiple comparisons with control (MCC – has been used for selecting the best treatment based on continuous variables. We selected the best hormonal replacement modality for successful multiple organ procurement using a two-step approach. First, we estimated the predicted margins by constructing generalized linear models (GLM or generalized linear mixed models (GLMM, and then we applied the multiple comparison methods to identify the best hormonal replacement modality given that the testing of hormonal replacement modalities is independent. Based on 10-year data from the United Network for Organ Sharing (UNOS, among 16 hormonal replacement modalities, and using the 95% simultaneous confidence intervals, we found that the combination of thyroid hormone, a corticosteroid, antidiuretic hormone, and insulin was the best modality for multiple organ procurement for transplantation. Keywords: best treatment selection, brain-dead organ donors, hormonal replacement, multiple binary endpoints, organ procurement, multiple comparisons

  17. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

    OpenAIRE

    Silviu Grisaru; Morgunov, Melissa A.; Samuel, Susan M.; Julian P Midgley; Wade, Andrew W; Tee, James B.; Hamiwka, Lorraine A.

    2011-01-01

    Acute kidney injury (AKI) is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS) remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT) and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 5...

  18. Acute Kidney Injury and Renal Replacement Therapy in Burns

    Directory of Open Access Journals (Sweden)

    Burak Canver

    2011-07-01

    Full Text Available Acute kidney injury (AKI is a common complication in patients with severe burn injury and one of the major causes of death. It has a negative prognostic value and almost always develops in the context of multiple organ dysfunction syndrome (MODS induced by sepsis. Over the last 20 years, according to data avaliable, the mortality rate has been reported to reach about 75%. Several definitions of AKI have been used , but nowadays the RIFLE classification is considered the gold standard, enabling a more objective comparison of populations. There are several ways to treat AKI in burn patients, including peritoneal dialysis (PD, intermittent hemodialysis, and continuous renal replacement therapy (CRRT. CRRT is generally used in patients in whom intermittent hemodialysis has failed to control hypovolemia, as well as in patients who cannot tolerate intermittent hemodialysis. Additionally, PD is not suitable for patients with burns within the abdominal area. For these reasons, most patients with unstable hemodynamic conditions receive CRRT. In burn patients with acute renal failure the dialytic treatment with continuous renal replacement therapies permitted us to achieve a survival and dialytic adequacy; however, mortality rate is high and related to septic shock and MODS. Despite the wide variation of the analysed burn populations and definitions of AKI, this review clearly showed that AKI remains prevalent and is associated with increased mortality in patients with severe burn injury. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 46-50

  19. Vascular access for extracorporeal renal replacement therapy in veterinary patients.

    Science.gov (United States)

    Chalhoub, Serge; Langston, Cathy E; Poeppel, Karen

    2011-01-01

    Vascular access is the first and most basic requirement for successful extracorporeal renal replacement therapy (ERRT). Dual-lumen catheters are the most commonly used method of vascular access for ERRT in veterinary patients. An adequately functioning dialysis catheter allows for smooth and efficient patient management, whereas a poorly functioning catheter frustrates the technician, doctor, and patient. These catheters are fairly quick to place but require meticulous care for optimal function. The most common complications are thrombosis and infection. Monitoring catheter performance should be a routine part of dialysis patient care.

  20. Current Status of Renal Replacement Therapy in Turkey: A Summary of Turkish Society of Nephrology 2009 Annual Registry Report

    Directory of Open Access Journals (Sweden)

    Gültekin SÜLEYMANLAR

    2011-01-01

    Full Text Available Turkish Society of Nephrology registry collects data on hemodialysis, peritoneal dialysis and transplantation on annual basis. Registry reports are printed every year as a booklet and this is the 20th year of registry reports. The registry is in close collaboration with international registries. In this paper data from the 2009 registry report are summarized, additionally yearly trends in the management of end stage renal disease are also provided The number of patients on renal replacement therapy is rapidly increasing, at the end of 2009, 59443 patients were on renal replacement therapy. The prevalence and incidence of end stage renal disease was 819 and 197 per million population respectively. Diabetes was the most important cause of end stage renal disease. Hemodialysis (78.5% was the most common type of treatment modality, followed by transplantation (12.4% and peritoneal dialysis (9.1% End stage renal disease is a very important and growing health problem for our country. Renal registry is a leading tool for providing current and sound data on this public health problem.

  1. Principles of antibacterial dosing in continuous renal replacement therapy.

    Science.gov (United States)

    Choi, Gordon; Gomersall, Charles D; Tian, Qi; Joynt, Gavin M; Freebairn, Ross; Lipman, Jeffrey

    2009-07-01

    To outline the concepts involved in optimizing antibacterial dosing in critically ill patients with acute renal failure undergoing continuous renal replacement therapy (CRRT), provide a strategy for optimizing dosing, and summarize the data required to implement the strategy. MEDLINE search from February 1986 to 2008. Optimal dosing of antibacterials is dependent on achieving pharmacokinetic targets associated with maximal killing of bacteria and improved outcomes. The initial dose is dependent on the volume of distribution. Maintenance doses are dependent on clearance. Both should be adjusted according to the pharmacokinetic target associated with optimal bacterial killing, when known. The volume of distribution of some antibacterials is altered by critical illness or acute renal failure or both. Clearance by CRRT is dependent on the dose and mode of CRRT and the sieving or saturation coefficient of the drug. Both sieving and saturation coefficient are related to the plasma protein binding and thus may be altered in renal failure. Appropriate dose calculation requires knowledge of the pharmacokinetic target and the usual minimum inhibitory concentration of the suspected organism in the patient's locality (or if unavailable, the break point for the organism), published pharmacokinetic data (volume of distribution, non-CRRT clearance) on critically ill patients receiving CRRT (which may differ substantially from noncritically ill patients or those without renal failure), the sieving or saturation coefficient of the relevant drug in critically ill patients, the dose and mode of CRRT being used, and the actual dose of CRRT that is delivered. This large number of variables results in considerable inter- and intrapatient heterogeneity in dose requirements. This article provides basic principles and relevant data to guide the clinician in prescribing individualized dosing regimes.

  2. Prevalence of patients receiving renal replacement therapy in El Salvador in 2014.

    Science.gov (United States)

    García-Trabanino, Ramón; Trujillo, Zulma; Colorado, Ana Verónica; Magaña Mercado, Salvador; Henríquez, Carlos Atilio

    El Salvador has the highest renal failure mortality rate in the Americas. Five healthcare providers offer renal replacement therapy (RRT) in the country. The national RRT prevalence has never been reported.

  3. Considerations for Medication Management and Anticoagulation During Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Thompson, Ashley; Li, Fanny; Gross, A Kendall

    2017-01-01

    Providing safe and high-quality care to critically ill patients receiving continuous renal replacement therapy (CRRT) includes adequate drug dosing and evaluation of patients' response to medications during therapy. Pharmacokinetic drug studies in acute kidney injury and CRRT are limited, considering the number of medications used in critical care. Therefore, it is important to understand the basic principles of drug clearance during CRRT by evaluating drug properties, CRRT modalities, and how they affect medication clearance. Few published studies have addressed drug disposition and clinical response during CRRT. Additionally, clotting in the CRRT circuit is a concern, so a few options for anticoagulation strategies are presented. This article reviews (1) the CRRT system and drug property factors that affect medication management, (2) the evidence available to guide drug dosing, and (3) anticoagulation strategies for critically ill patients receiving CRRT. ©2017 American Association of Critical-Care Nurses.

  4. Predictors of Renal Replacement Therapy in Acute Kidney Injury

    Directory of Open Access Journals (Sweden)

    Michael J. Koziolek

    2012-09-01

    Full Text Available Backgrounds: Criteria that may guide early renal replacement therapy (RRT initiation in patients with acute kidney injury (AKI currently do not exist. Methods: In 120 consecutive patients with AKI, clinical and laboratory data were analyzed on admittance. The prognostic power of those parameters which were significantly different between the two groups was analyzed by receiver operator characteristic curves and by leave-1-out cross validation. Results: Six parameters (urine albumin, plasma creatinine, blood urea nitrogen, daily urine output, fluid balance and plasma sodium were combined in a logistic regression model that estimates the probability that a particular patient will need RRT. Additionally, a second model without daily urine output was established. Both models yielded a higher accuracy (89 and 88% correct classification rate, respectively than the best single parameter, cystatin C (correct classification rate 74%. Conclusions: The combined models may help to better predict the necessity of RRT using clinical and routine laboratory data in patients with AKI.

  5. Continuous renal replacement therapy circuit failure after antidote administration.

    Science.gov (United States)

    Jeong, Jinwoo

    2014-12-01

    A 73-year-old man was transferred to the emergency department (ED). He was found unconscious in his house along with an empty 200-mL bottle of Basta(™), a herbicide containing 18% glufosinate. He was comatose with a Glasgow Coma Scale score of 3. As his blood pressure dropped to 60/30 mmHg despite fluids and norepinephrine, 20% intravenous fat emulsion product was injected. He experienced repeated cardiopulmonary arrests during his first 4 h in the ED. When the arrests occurred, standard cardiopulmonary resuscitation was performed, and boluses of fat emulsion were given. He was given a total of 1500 mL of 20% fat emulsion. In an attempt to correct the acidosis, continuous renal replacement therapy (CRRT) was started. Within 5 min of starting CRRT, the transmembrane pressure increased sharply and the machine stopped.

  6. Ultrafiltration rate is an important determinant of microcirculatory alterations during chronic renal replacement therapy.

    Science.gov (United States)

    Veenstra, Gerke; Pranskunas, Andrius; Skarupskiene, Inga; Pilvinis, Vidas; Hemmelder, Marc H; Ince, Can; Boerma, E Christiaan

    2017-02-20

    Hemodialysis (HD) with ultrafiltration (UF) in chronic renal replacement therapy is associated with hemodynamic instability, morbidity and mortality. Sublingual Sidestream Dark Field (SDF) imaging during HD revealed reductions in microcirculatory blood flow (MFI). This study aims to determine underlying mechanisms. The study was performed in the Medical Centre Leeuwarden and the Lithuanian University of Health Sciences. Patients underwent 4-h HD session with linear UF. Nine patients were subject to combinations of HD and UF: 4 h of HD followed by 1 h isolated UF and 4 h HD with blood-volume-monitoring based UF. Primary endpoint: difference in MFI before and after intervention. During all sessions monitoring included blood pressure, heartrate and SDF-imaging. NCT01396980. Baseline characteristics were not different between the two centres as within the HD/UF modalities. MFI was not different before and after HD with UF. Total UF did not differ between modalities. Median MFI decreased significantly during isolated UF [2.8 (2.5-2.9) to 2.5 (2.2-2.8), p = 0.03]. Baseline MFI of each UF session was correlated with MFI after the intervention (r s = 0.52, p = 0.006). During HD with UF or isolated HD we observed no changes in MFI. This indicates that non-flow mediated mechanisms are of unimportance. During isolated UF we observed a reduction in MFI in conjunction with a negative intravascular fluid balance. The correlation between MFI before and after intervention suggests that volume status at baseline is a factor in microvascular alterations. In conclusion we observed a significant decrease of sublingual MFI, related to UF rate during chronic renal replacement therapy.

  7. Status of renal replacement therapy and peritoneal dialysis in Mexico.

    Science.gov (United States)

    Cueto-Manzano, Alfonso M; Rojas-Campos, Enrique

    2007-01-01

    Mexico is struggling to gain a place among developed countries; however, there are many socioeconomic and health problems still waiting for resolution. While Mexico has the twelfth largest economy in the world, a large portion of its population is impoverished. Treatment for end-stage renal disease (377 patients per million population) is determined by the individual's access to resources such as private medical care (approximately 3%) and public sources (Social Security System: approximately 40%; Health Secretariat: approximately 57%). With only 6% of the gross national product spent on healthcare and most treatment providers being public health institutions that are often under economic restrictions, it is not surprising that many Mexican patients do not receive renal replacement therapy. Mexico is still the country with the largest utilization of peritoneal dialysis (PD) in the world, with 18% on automated PD, 56% on continuous ambulatory PD (CAPD), and 26% on hemodialysis. Results of PD (patient morbi-mortality, peritonitis rate, and technique survival) in Mexico are comparable to other countries. However, malnutrition and diabetes mellitus are highly prevalent in Mexican patients on CAPD programs, and these conditions are among the most important risk factors for a poor outcome in our setting.

  8. Quality of pharmacokinetic studies in critically ill patients receiving continuous renal replacement therapy.

    Science.gov (United States)

    Vaara, S; Pettila, V; Kaukonen, K-M

    2012-02-01

    Continuous renal replacement therapy (CRRT) is the preferred renal replacement therapy modality in the critically ill. We aimed to reveal the literature on the pharmacokinetic studies in critically ill patients receiving CRRT with special reference to quality assessment of these studies and the CRRT dose. We conducted a systematic review by searching the MEDLINE, EMBASE, and the Cochrane databases to December 2009 and bibliographies of relevant review articles. We included original studies reporting from critically ill adult subjects receiving CRRT because of acute kidney injury with a special emphasis on drug pharmacokinetics. We used the minimum reporting criteria for CRRT studies by Acute Dialysis Quality Initiative (ADQI) and, second, the Downs and Black checklist to assess the quality of the studies. We calculated the CRRT dose per study. We included pharmacokinetic parameters, residual renal function, and recommendations on drug dosing. Of 182 publications, 95 were considered relevant and 49 met the inclusion criteria. The median [interquartile range (IQR)] number of reported criteria by ADQI was 7.0 (5.0-8.0) of 12. The median (IQR) Downs and Black quality score was 15 (14-16) of 32. None of the publications reported CRRT dose directly. The median (IQR) weighted CRRT dose was 23.7 (18.8-27.9) ml/kg/h. More attention should be paid both to standardizing the CRRT dose and reporting of the CRRT parameters in pharmacokinetic studies. The general quality of the studies during CRRT in the critically ill was only moderate and would be greatly improved by reports in concordant with the ADQI recommendations. © 2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

  9. Analgesic Nephropathy and Renal Replacement Therapy in Australia: Trends, Comorbidities and Outcomes

    OpenAIRE

    Chang, Sean Haw; Mathew, Timothy Hamish; McDonald, Stephen Peter

    2008-01-01

    Background and objectives: This study examined age-specific incidence and prevalence of renal replacement therapy attributed to analgesic nephropathy from 1971 through 2005 and adjusted comorbidity prevalence and survival of patients who had analgesic nephropathy and were on renal replacement therapy (compared with control subjects without diabetes).

  10. Aortic Valve Replacement for Infective Endocarditis in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Masmoudi Sayda

    2000-01-01

    Full Text Available Renal transplant recipients are more prone to developing infections. We report a 37-year old renal transplant recipient who developed infective endocarditis of the aortic valve, heart failure and renal allograft dysfunction. He underwent aortic valve replacement which was followed by improvement in cardiac as well as allograft function.

  11. β-lactam antibiotic concentrations during continuous renal replacement therapy

    Science.gov (United States)

    2014-01-01

    Introduction The use of standard doses of β-lactam antibiotics during continuous renal replacement therapy (CRRT) may result in inadequate serum concentrations. The aim of this study was to evaluate the adequacy of unadjusted drug regimens (i.e., similar to those used in patients with normal renal function) in patients treated with CRRT and the influence of CRRT intensity on drug clearance. Methods We reviewed data from 50 consecutive adult patients admitted to our Department of Intensive Care in whom routine therapeutic drug monitoring (TDM) of broad-spectrum β-lactam antibiotics (ceftazidime or cefepime, CEF; piperacillin/tazobactam; TZP; meropenem, MEM) was performed using unadjusted β-lactam antibiotics regimens (CEF = 2 g q8h; TZP = 4 g q6h; MEM = 1 g q8h). Serum drug concentrations were measured twice during the elimination phase by high-performance liquid chromatography (HPLC-UV). We considered therapy was adequate when serum drug concentrations were between 4 and 8 times the minimal inhibitory concentration (MIC) of Pseudomonas aeruginosa during optimal periods of time for each drug (≥70% for CEF; ≥ 50% for TZP; ≥ 40% for MEM). Therapy was considered as early (ET) or late (LT) phase if TDM was performed within 48 hours of antibiotic initiation or later on, respectively. Results We collected 73 serum samples from 50 patients (age 58 ± 13 years; Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission 21 (17–25)), 35 during ET and 38 during LT. Drug concentrations were above 4 times the MIC in 63 (90%), but above 8 times the MIC in 39 (53%) samples. The proportions of patients with adequate drug concentrations during ET and LT were quite similar. We found a weak but significant correlation between β-lactam antibiotics clearance and CRRT intensity. Conclusions In septic patients undergoing CRRT, doses of β-lactam antibiotics similar to those given to patients with normal renal function achieved drug

  12. Technological advances in renal replacement therapy: five years and beyond.

    Science.gov (United States)

    Rastogi, Anjay; Nissenson, Allen R

    2009-12-01

    The worldwide epidemic of chronic kidney disease shows no signs of abating in the near future. Current dialysis forms of renal replacement therapy (RRT), even though successful in sustaining life and improving quality of life somewhat for patients with ESRD, have many limitations that result in still unacceptably high morbidity and mortality. Transplantation is an excellent option but is limited by the scarcity of organs. An ideal form of RRT would mimic the functions of natural kidneys and be transparent to the patient, as well as affordable to society. Recent advances in technology, although generally in early stages of development, might achieve these goals. The application of nanotechnology, microfluidics, bioreactors with kidney cells, and miniaturized sorbent systems to regenerate dialysate makes clinical reality seem closer than ever before. Finally, stem cells hold much promise, both for kidney disease and as a source of tissues and organs. In summary, nephrology is at an exciting crossroad with the application of innovative and novel technologies to RRT that hold considerable promise for the near future.

  13. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy : special considerations in pediatric patients.

    Science.gov (United States)

    Veltri, Michael A; Neu, Alicia M; Fivush, Barbara A; Parekh, Rulan S; Furth, Susan L

    2004-01-01

    Chronic renal failure is, fortunately, an unusual occurrence in children; however, many children with various underlying illnesses develop acute renal failure, and transiently require renal replacement therapy - peritoneal dialysis, intermittent hemodialysis (IHD), or continuous renal replacement therapy (CRRT). As children with acute and chronic renal failure often have multiple comorbid conditions requiring drug therapy, generalists, intensivists, nephrologists, and pharmacists need to be aware of the issues surrounding the management of drug therapy in pediatric patients undergoing renal replacement therapy. This article summarizes the pharmacokinetics and dosing of many drugs commonly prescribed for pediatric patients, and focuses on the management of drug therapy in pediatric patients undergoing IHD and CRRT in the intensive care unit setting. Peritoneal dialysis is not considered in this review. Finally, a summary table with recommended initial dosages for drugs commonly encountered in pediatric patients requiring IHD or CRRT is presented.

  14. Do the outcomes of living donor renal allograft recipients differ with peritoneal dialysis and hemodialysis as a bridge renal replacement therapy?

    Science.gov (United States)

    Prasad, Narayan; Vardhan, Harsh; Baburaj, Vinod P; Bhadauria, Dharmendra; Gupta, Amit; Sharma, Raj K; Kaul, Anupama

    2014-11-01

    This study was undertaken to compare the outcomes of living donor renal transplant recipients using peritoneal dialysis (PD) and hemodialysis (HD) as a bridge modality for renal replacement therapy till renal transplantation. The demographic profiles of the recipients and donors, the patients' native kidney disease (diabetic versus non-diabetic), duration on dialysis, requirement of anti-hypertensive drugs, number of blood transfusions, human leukocyte antigen (HLA) mismatch status, pre- and post-transplant infectious complications, and post-transplant outcomes of patients were compared between the two groups. The demographic features of the study patients were similar in the two groups. The duration of dialysis prior to transplant was significantly longer in the PD group than in the HD group of patients. The anti-hypertensive drug requirement was lower and the hemoglobin level and residual urine volume at the time of transplant were relatively better in the PD patients compared to the HD patients. The number of acute rejection episodes, delayed graft function, surgical complications, glomerular filtration rate at one month and at the last follow-up, were also similar in both groups. The short-term and long-term graft survival was similar in both groups of patients. The one-, two-, five-, and eight-year death-censored graft survival rates of the PD patients were 98, 95, 85, and 73%, respectively, and in the HD group of patients, they were 100, 93, 84, and 79%, respectively. The one-, two-, five-, and eight-year patient survival rates in the PD group were 97, 92, 77, and 66%, respectively, and in the HD group, they were 97, 92, 79, and 69%, respectively. Our study suggests that the outcomes of the living donor renal allograft recipients did not differ between the groups of patients who used PD or HD as renal replacement therapy prior to renal transplantation.

  15. Do the outcomes of living donor renal allograft recipients differ with peritoneal dialysis and hemodialysis as a bridge renal replacement therapy?

    Directory of Open Access Journals (Sweden)

    Narayan Prasad

    2014-01-01

    Full Text Available This study was undertaken to compare the outcomes of living donor renal transplant recipients using peritoneal dialysis (PD and hemodialysis (HD as a bridge modality for renal replacement therapy till renal transplantation. The demographic profiles of the recipients and donors, the patients′ native kidney disease (diabetic versus non-diabetic, duration on dialysis, requirement of anti-hypertensive drugs, number of blood transfusions, human leukocyte antigen (HLA mismatch status, pre- and post-transplant infectious complications, and post-transplant outcomes of patients were compared between the two groups. The demographic features of the study patients were similar in the two groups. The duration of dialysis prior to transplant was significantly longer in the PD group than in the HD group of patients. The anti-hypertensive drug requirement was lower and the hemoglobin level and residual urine volume at the time of transplant were relatively better in the PD patients compared to the HD patients. The number of acute rejection episodes, delayed graft function, surgical complications, glomerular filtration rate at one month and at the last follow-up, were also similar in both groups. The short-term and long-term graft survival was similar in both groups of patients. The one-, two-, five-, and eight-year death-censored graft survival rates of the PD patients were 98, 95, 85, and 73%, respectively, and in the HD group of patients, they were 100, 93, 84, and 79%, respectively. The one-, two-, five-, and eight-year patient survival rates in the PD group were 97, 92, 77, and 66%, respectively, and in the HD group, they were 97, 92, 79, and 69%, respectively. Our study suggests that the outcomes of the living donor renal allograft recipients did not differ between the groups of patients who used PD or HD as renal replacement therapy prior to renal transplantation.

  16. Risk of major depression in patients with chronic renal failure on different treatment modalities: A matched-cohort and population-based study in Taiwan.

    Science.gov (United States)

    Chen, Shih-Feng; Wang, I-Jen; Lang, Hui-Chu

    2016-01-01

    The influence of different treatment modalities on the risk of developing major depression in patients with chronic renal failure (CRF) is not well understood. We aimed to explore the incidence of major depression among patients with CRF who were on different dialysis modalities, who had received renal transplantation (RT), and those who had not yet received any of the aforementioned renal replacement therapies. We conducted a population-based retrospective cohort study using a national health insurance research database. This study investigated 89,336 study controls, 17,889 patients with chronic kidney disease on conservative treatment, 3823 patients on hemodialysis (HD), 351 patients on peritoneal dialysis (PD), and 322 patients who had RT. We followed all individuals until the occurrence of major depression or the date of loss to follow-up. The PD group had the highest risk (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.26-4.69), whereas the RT group had the lowest risk (HR 0.18; 95% CI 0.03-1.29) of developing major depression compared with the control group. Patients initiated on PD had a higher risk of developing major depression than patients initiated on HD (pairwise comparison: HR 2.20; 95% CI 1.09-4.46). Different treatment modalities are associated with different risks of developing major depression in patients with CRF. Among renal replacement therapies, patients who have had RT have the lowest risk of developing major depression. Patients who initiate renal therapy on PD may have a higher risk of major depression compared with patients who initiate renal therapy on HD.

  17. Multimodality Imaging in the Context of Transcatheter Mitral Valve Replacement: Establishing Consensus Among Modalities and Disciplines.

    Science.gov (United States)

    Blanke, Philipp; Naoum, Christopher; Webb, John; Dvir, Danny; Hahn, Rebecca T; Grayburn, Paul; Moss, Robert R; Reisman, Mark; Piazza, Nicolo; Leipsic, Jonathon

    2015-10-01

    Transcatheter mitral valve implantation (TMVI) represents a promising approach to treating mitral valve regurgitation in patients at increased risk of perioperative mortality. Similar to transcatheter aortic valve replacement (TAVR), TMVI relies on pre- and periprocedural noninvasive imaging. Although these imaging modalities, namely echocardiography, computed tomography, and fluoroscopy, are well established in TAVR, TMVI has entirely different requirements. Approaches and nomenclature need to be standardized given the multiple disciplines involved. Herein we provide an overview of anatomical principles and definitions, a methodology for anatomical quantification, and perioperative guidance.

  18. Using continuous renal replacement therapy to manage patients of shock and acute renal failure

    Directory of Open Access Journals (Sweden)

    Soni Sachin

    2009-01-01

    Full Text Available Background: The incidence of acute renal failure (ARF in the hospital setting is increasing. It portends excessive morbidity and mortality and a considerable burden on hospital resources. Extracorporeal therapies show promise in the management of patients with shock and ARF. It is said that the potential of such therapy goes beyond just providing renal support. The aim of our study was to analyze the clinical setting and outcomes of critically ill ARF patients managed with continuous renal replacement therapy (CRRT. Patients and Methods: Ours was a retrospective study of 50 patients treated between January 2004 and November 2005. These 50 patients were in clinical shock and had concomitant ARF. All of these patients underwent CVVHDF (continuous veno-venous hemodiafiltration in the intensive care unit. For the purpose of this study, shock was defined as systolic BP < 100 mm Hg in spite of administration of one or more inotropic agents. SOFA (Sequential Organ Failure Assessment score before initiation of dialysis support was recorded in all cases. CVVHDF was performed using the Diapact ® (Braun CRRT machine. The vascular access used was as follows: femoral in 32, internal jugular in 8, arteriovenous fistula (AVF in 4, and subclavian in 6 patients. We used 0.9% or 0.45% (half-normal saline as a prefilter replacement, with addition of 10% calcium gluconate, magnesium sulphate, sodium bicarbonate, and potassium chloride in separate units, while maintaining careful monitoring of electrolytes. Anticoagulation of the extracorporeal circuit was achieved with systemic heparin in 26 patients; frequent saline flushes were used in the other 24 patients. Results: Of the 50 patients studied, 29 were males and 21 females (1.4:1. The average age was 52.88 years (range: 20-75 years. Causes of ARF included sepsis in 24 (48%, hemodynamically mediated renal failure (HMRF in 18 (36%, and acute over chronic kidney disease in 8 (16% patients. The overall mortality was

  19. Development of continuous implantable renal replacement: past and future.

    Science.gov (United States)

    Fissell, William H; Fleischman, Aaron J; Humes, H David; Roy, Shuvo

    2007-12-01

    Most of the 400,000+ patients in the United States with kidney failure depend on dialysis treatments in dedicated dialysis centers for 3 h to 5 h, usually 3 times a week, but they still suffer from accelerated cardiovascular disease and infections. Extended daily dialysis, for 6 to 8 hours every day, seems to be associated with better outcomes but would overwhelm the dialysis networks and severely limit patient activity. Technology to miniaturize and automate home dialysis will be necessary to offer extended daily dialysis to most dialysis patients. Miniaturization of existing hollow-fiber polymer membranes is constrained by requirements for high driving pressures for circulation and convective clearance. Recent advances in membrane technology based on microelectromechanical systems (MEMS) promise to enable the development of continuous implantable renal replacement therapy. Silicon nanoporous membranes with a highly monodisperse pore size distribution have been produced using protocols amenable to low-cost batch fabrication similar to those used to produce microelectronics. Hydraulic permeability of the flat-sheet membranes with critical pore sizes in the range of 8-100 nm has been measured to confirm that conventional fluid transport models are sufficiently accurate for predictive design for bulk liquid flow in an implantable hemofilter. Membrane biocompatibility was tested in vitro with human proximal tubule cells and revealed that silicon does not exhibit cytotoxicity, as evidenced by the formation of confluent cell layers with tight junctions and central cilia. Filtration characterization demonstrated that the nanoporous membranes exhibit size-dependent solute rejection in agreement with steric hindrance models. These advances in membrane technology are fundamentally enabling for a paradigm shift from an in-center to implantable dialysis system.

  20. Measuring biomarkers of acute kidney injury during renal replacement therapy: wisdom or folly?

    Science.gov (United States)

    Ostermann, Marlies; Forni, Lui G

    2014-06-19

    Early data are now appearing relating to the measurement of biomarkers of acute kidney injury during renal replacement therapy. These data go some way in describing the clearance of these molecules during renal support. Understanding the potential clearance, or otherwise, of these proteins may lead to directing our therapies in the future particularly with regard to cessation of renal support. We describe a recent study which has provided data that may aid in addressing this issue.

  1. Renal histology before and after effective enzyme replacement therapy in a patient with classical Fabry's disease.

    Science.gov (United States)

    Hirashio, S; Taguchi, T; Naito, T; Maki, K; Ogata, S; Taniyama, K; Taniguchi, Y; Yorioka, N

    2009-05-01

    A 38-year-old man underwent renal biopsy because of proteinuria. It revealed swelling and vacuolation of glomerular epithelial cells, as well as myelin-like structures characteristic of Fabry's disease. Detection of decreased plasma activity of alpha-galactosidase A confirmed the diagnosis. Enzyme replacement therapy was provided with recombinant agalsidase-beta, resulting in improvement of his symptoms. When renal biopsy was repeated, specific staining for globotriaosylceramide showed that renal deposits were decreased by enzyme therapy.

  2. Laboratory prediction of the requirement for renal replacement in acute falciparum malaria

    NARCIS (Netherlands)

    Hanson, J.; Hasan, M.M.U.; Royakkers, A.A.; Alam, S.; Charunwatthana, P.; Maude, R.J.; Douthwaite, S.T.; Yunus, E.B.; Mantha, M.L.; Schultz, M.J.; Faiz, M.A.; White, N.J.; Day, N.P.; Dondorp, A.M.

    2011-01-01

    Acute renal failure is a common complication of severe malaria in adults, and without renal replacement therapy (RRT), it carries a poor prognosis. Even when RRT is available, delaying its initiation may increase mortality. Earlier identification of patients who will need RRT may improve outcomes. P

  3. Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe

    DEFF Research Database (Denmark)

    Spithoven, Edwin M; Kramer, Anneke; Meijer, Esther

    2014-01-01

    BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD. METHODS: This study used data from the ERA-EDTA Registry...

  4. Outcomes of male patients with Alport syndrome undergoing renal replacement therapy

    DEFF Research Database (Denmark)

    Temme, Johanna; Kramer, Anneke; Jager, Kitty J;

    2012-01-01

    Patients with the hereditary disease Alport syndrome commonly require renal replacement therapy (RRT) in the second or third decade of life. This study compared age at onset of RRT, renal allograft, and patient survival in men with Alport syndrome receiving various forms of RRT (peritoneal dialys...

  5. Incidence of renal replacement therapy for diabetic nephropathy in the Netherlands: Dutch diabetes estimates (DUDE)-3

    NARCIS (Netherlands)

    Dijk, P.R. van; Kramer, A.; Logtenberg, S.J.; Hoitsma, A.J.; Kleefstra, N.; Jager, K.J.; Bilo, H.J.G.

    2015-01-01

    OBJECTIVES: Describe the incidence, prevalence and survival of patients needing renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetes mellitus (DM)-related glomerulosclerosis or nephropathy (diabetic nephropathy, DN) in the Netherlands. DESIGN: Using the national registr

  6. Incidence of renal replacement therapy for diabetic nephropathy in the Netherlands : Dutch diabetes estimates (DUDE)-3

    NARCIS (Netherlands)

    van Dijk, Peter R.; Kramer, Anneke; Logtenberg, Susan J. J.; Hoitsma, Andries J.; Kleefstra, Nanne; Jager, Kitty J.; Bilo, Henk J. G.

    2015-01-01

    Objectives: Describe the incidence, prevalence and survival of patients needing renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetes mellitus (DM)-related glomerulosclerosis or nephropathy (diabetic nephropathy, DN) in the Netherlands. Design: Using the national registr

  7. Incidence of renal replacement therapy for diabetic nephropathy in the Netherlands: Dutch diabetes estimates (DUDE)-3

    NARCIS (Netherlands)

    Dijk, P.R. van; Kramer, A.; Logtenberg, S.J.; Hoitsma, A.J.; Kleefstra, N.; Jager, K.J.; Bilo, H.J.G.

    2015-01-01

    OBJECTIVES: Describe the incidence, prevalence and survival of patients needing renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetes mellitus (DM)-related glomerulosclerosis or nephropathy (diabetic nephropathy, DN) in the Netherlands. DESIGN: Using the national

  8. Modality

    DEFF Research Database (Denmark)

    Klinge, Alex; Müller, Henrik Høeg

    Modality: Studies in Form and Function reflects the diversity of theoretical frameworks and the heterogeneity of linguistic phenomena under the general heading of modality. Researchers in the fields of logic, philosophy and linguistics have for many years been pondering the elusive nature...

  9. Continuous Renal Replacement Therapy and Extracorporeal Membrane Oxygenation in Cardias Surgery

    Directory of Open Access Journals (Sweden)

    S. V. Kolesnikov

    2014-01-01

    Full Text Available Objective: to analyze the combined use of extracorporeal membrane oxygenation (ECMO and continuous renal replacement therapy with switching into the ECMO circuit in cardiac surgical patients over 18 years of age and to reveal predictors of a fatal outcome in this combination of auxiliary organ support techniques. Materials and methods. The retrospective cohort study postoperatively used a combination of ECMO and continuous renal replacement therapy in 27 cardiac surgical patients aged over 18 years with severe cardiopulmonary insufficiency concurrent with acute kidney lesion. In all cases, the continuous renal replacement therapy circuit was switched into the line after an ECMO pump. The end points of the study were the duration of dialysis-dependent acute renal failure, the frequency of complications, and hospital mortality. Results. In all cases with a favorable outcome, the duration of continuous renal replacement therapy was 3 days longer than that of ECMO. There were no cases of recovery if the duration of continuous renal replacement therapy was shorter than that of ECMO and the duration of the latter was more than 10 days. The duration of sympathomimetic support (>3.5 days was shown to be an independent and significant predictor of death (AUC 0.99; CI 99.9%, 0.96—1.0 in the patients receiving continuous renal replacement therapy and ECMO. It was established that the number of inotrophic drugs (>2 and the highest lactate level (>1.99 mmol/l could be used to predict hospital mortality in patients with acute kidney injury and severe cardiopulmonary insufficiency (AUC 0.85 and 0.86; sensitivity/specificity 0.83/0.67 and 0.86/0.67, respectively.Conclusion. The concurrent use of ECMO and continuous renal replacement therapy in severe cardiac surgical patients with potentially reversible cardiopulmonary insufficiency and acute kidney injury is a sound and complementary combination of auxiliary organ support techniques.  

  10. Is there a risk of permanent renal dysfunction after primary total hip and knee joint replacements?

    DEFF Research Database (Denmark)

    Hassan, Basim Kamil; Dessau, Ram Benny; Sahlström, Arne

    2016-01-01

    primary total hip and knee joint replacements. METHODS: Long-term postoperative renal dysfunction was analyzed in a retrospective study of 1301 consecutive primary total hip and knee joint replacements performed between January 2009 and December 2013. According to the RIFLE criteria, increased serum...

  11. Efficacy of continuous renal replacement therapy on patients with severe pulmonary infection

    Institute of Scientific and Technical Information of China (English)

    Ji-Feng Wang; Wen-Qiang Li; Peng Xu; Xiao-Yun Liu; Wen-Li Ji

    2016-01-01

    Objective:To analyze the efficacy of continuous renal replacement therapy on patients with severe pulmonary infection. Method:A total of 50 patients with severe pulmonary infection in our hospital from May 2014 to May 2015 were selected and were given continuous renal replacement therapy. Clinical symptoms, acute physiology and chronic health evaluation(APACHE)Ⅱ, blood routine and blood gas indexes, renal function (urea, creatinine, uric acid) and electrolyte (blood potassium, blood sodium) changes and success rate of treatment were observed and analyzed before and after treatment. Results:After continuous renal replacement therapy, dyspnea was significantly relieved for 47 cases of patients. Temperature was decreased accordingly. After treatment, electrolyte, APACHEⅡand renal function of patients were significantly improved (P<0.01);blood routine and blood gas indexes were signiicantly improved (P<0.01). Successful cases:36;death cases:14. Conclusions:continuous renal replacement therapy had better efficacy and could effectively improve the electrolyte, APACHEⅡand renal function for patients with severe pulmonary infection, which is an effective kind of adjuvant therapy.

  12. Characteristics and Outcomes of Granulomatosis With Polyangiitis (Wegener) and Microscopic Polyangiitis Requiring Renal Replacement Therapy: Results From the European Renal Association-European Dialysis and Transplant Association Registry

    NARCIS (Netherlands)

    Hruskova, Z.; Stel, V.S.; Jayne, D.; Aasarod, K.; Meester, J. de; Ekstrand, A.; Eller, K.; Heaf, J.G.; Hoitsma, A.J.; Jimenez, C. Martos; Ravani, P.; Wanner, C.; Tesar, V.; Jager, K.J.

    2015-01-01

    BACKGROUND: This study describes the incidence and outcomes of European patients requiring renal replacement therapy (RRT) for kidney failure due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 12 renal registries providi

  13. [Management of patients with end-stage renal disease prior to initiation of renal replacement therapy in 2013 in France].

    Science.gov (United States)

    Tuppin, Philippe; Cuerq, Anne; Torre, Sylvie; Couchoud, Cécile; Fagot-Campagna, Anne

    2017-04-01

    This study evaluated the management of patients with end-stage renal disease prior to initiation of renal replacement therapy. Among the 51 million national health insurance general scheme beneficiaries (77% of the population), persons 18 years and older, starting dialysis or undergoing preemptive renal transplantation in 2013, were included in this study. Data were derived from the French national health insurance system (SNIIRAM). In this population of 6674 patients (median age: 68 years), 88% initiated renal replacement therapy by haemodialysis, 8% by peritoneal dialysis, and 4% by renal transplantation. During the year preceding initiation of dialysis, 76% of patients had been hospitalised with at least one diagnostic code for renal disease in 83% of cases, 16% had not received any reimbursements for serum creatinine assay and 32% had not seen a nephrologist; 87% were taking at least one antihypertensive drug (60% were taking at least a renin-angiotensin system inhibitor) and 30% were taking a combination of 4 or more classes of antihypertensive drugs. For patients initiating haemodialysis in a haemodialysis centre, 39% had undergone a procedure related to arteriovenous fistula and 10% had been admitted to an intensive care unit. This study, based on the available reimbursement data, shows that, despite frequent use of the health care system by this population, there is still room for improvement of screening and management of patients with end-stage renal disease and preparation for renal replacement therapy. Copyright © 2016 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.

  14. The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy.

    Science.gov (United States)

    Antonucci, Elio; Lamanna, Irene; Fagnoul, David; Vincent, Jean-Louis; De Backer, Daniel; Silvio Taccone, Fabio

    2016-08-01

    Acute kidney injury (AKI) is common in patients treated with veno-arterial (VA-) or veno-venous (VV-) extracorporeal membrane oxygenation (ECMO). In this setting, the use of continuous renal replacement therapy (CRRT) can help to optimize fluid status but may also negatively impact on patients' outcome. In contrast, the relationship between AKI, CRRT, and survival in critically ill adult patients receiving ECMO is not well defined. The institutional ECMO database (n = 162) from November 2008 to December 2013, excluding patients with ICU survival ECMO and 56 with VV-ECMO). Of these, 95 developed AKI, 63 (47%) of whom required CRRT; thus three groups of patients were identified: (a) no AKI; (b) AKI without CRRT (AKINOCRRT ); and (c) CRRT with AKI (AKICRRT ). AKINOCCRT patients were more likely to have preexisting heart disease, to be more severely ill, and to be treated with VA-ECMO than those without AKI. AKICRRT patients were also more likely to be treated with VA-ECMO, had more organ dysfunction at the time of ECMO insertion, and needed more transfusions and inotropic agents than patients without AKI. ICU mortality was 53% (72/135) and was similar in the three groups, even when different AKI stages or VA/VV-ECMO were analyzed separately. In this study, the use of CRRT was not associated with an increased mortality in an adult population of patients treated with ECMO, even after adjustment for confounders.

  15. [Continuous veno-venous renal replacement therapies in critically ill neonates and children].

    Science.gov (United States)

    López-Herce Cid, J; Carrillo Alvarez, A; Panadero Carlavilla, E; Sánchez Sánchez, C; Moral Torrero, R; Bustinza Arriourtúa, A

    1998-07-01

    The objective of this study was to analyze the efficacy of continuous veno-venous renal replacement therapies in neonates and children. We analyzed 10 episodes of acute renal failure in 9 patients, between 7 days and 2 years of age and weighing between 2.9 and 13 kg, treated with continuous veno-venous renal replacement therapies (hemofiltration or hemodiafiltration) by using a BSM-32-IC (Hospal) monitor and two types of hemofilters, Miniflow of 0.04 m2 (Hospal) and FH22 of 0.2 m2 (Gambro). We used a blood flow between 15 and 40 ml/min and obtained an ultrafiltration rate of 190 +/- 61 ml/hour. The mean life of the hemofilters was 16 +/- 14 hours, with the duration of the technique between 5 and 58 hours. In three episodes the technique was ended because of normalization of renal function. All patients tolerated continuous renal replacement therapies without important secondary effects (one patient had moderate ischemia of the leg because of erroneous arterial catheterization, 3 patients had electrolyte alterations. 1 patient had hypothermia and 5 patients needed platelet transfusions). Seven patients died because of shock and multiple organ failure which was not related to the technique. Continuous veno-venous renal replacement therapies are useful in the treatment of critically ill children. Veno-venous techniques can be used in term neonate and infants.

  16. Renal Replacement Therapy in Support of Combat Operations

    Science.gov (United States)

    2008-07-01

    was used to create viable sets; pediatric chest tubes were used as PD catheters and dialysate was made using either intravenous saline solution with...important logistic factor in performing RRT is the volume of fluid required for dialysate (for hemodi- alysis and peritoneal dialysis) or replace- ment...treatment may range on the order of 100 to 1000 L per day per patient. Both the dialysate and replacement fluid must be sterile, and no approach for

  17. Dialysis Modality Preferences and Quality of Life of Adolescents with Renal Failure

    Directory of Open Access Journals (Sweden)

    Afsheen Masood

    2016-04-01

    Full Text Available The present research explored the differences in perceived quality of life of adolescents afflicted with End stage renal disease (ESRD/ renal failure with reference to different dialysis modality. It was hypothesized that there would be significant differences in the reported quality of life of the patients of end stage renal disease that are going through either hemodialysis or peritoneal dialysis. Employing ex-post facto research design and nonprobability purposive sampling technique, a sample of (n=70 patients with renal failure was accessed from various hospitals. Quality of life was measured through the Pediatric Inventory of Quality of Life (PedsQL™ Version 4.0 Core Scales, while Dialysis Symptom Index and Brief Cope were also employed. The results revealed that the patients with peritoneal dialysis (PD indicated greater quality of life than hemodialysis patients (HD while Aggravated dialysis symptoms emerged as strong predictors of poorer quality of life among adolescents. The impact of the event scale reflected that there were greater scores for the patients with PD than the patients with HD, revealing that life situations are construed as more impact oriented by the adolescents going through PD. The current findings provide direction to health professionals to work on spreading awareness to parents and professional community about significance of raising quality of life of adolescence, afflicted with ESRD. The results carry significant implication for health professionals to envision the devising of effective strategies for improving the quality of life of Adolescents with ESRD.

  18. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury.

    Science.gov (United States)

    Elseviers, Monique M; Lins, Robert L; Van der Niepen, Patricia; Hoste, Eric; Malbrain, Manu L; Damas, Pierre; Devriendt, Jacques

    2010-01-01

    Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT. Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge. Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group. The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be warranted.

  19. Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

    OpenAIRE

    Thomas, Bernadette A.; Logar, Christine M.; Anderson, Arthur E.

    2012-01-01

    “Cardiorenal syndrome” is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a u...

  20. Renal replacement therapy for rare diseases affecting the kidney

    DEFF Research Database (Denmark)

    Wühl, Elke; van Stralen, Karlijn J; Wanner, Christoph

    2014-01-01

    and separately for children and adults. METHODS: The Orphanet classification of rare disease was searched for rare diseases potentially causing ESRD, and these diagnosis codes were mapped to the corresponding ERA-EDTA primary renal disease codes. Thirty-one diagnoses were defined as rare diseases causing ESRD...... disease affected young patients in up to 46%. On 31 December 2011, 20 595 patients (12.4% of the total RRT population) were on RRT for ESRD caused by a rare disease. The point prevalence was 32.5 per million age-related population in children and 152.0 in adults. Only 5.8% of these patients were younger...

  1. Understanding the continuous renal replacement therapy circuit for acute renal failure support: a quality issue in the intensive care unit.

    Science.gov (United States)

    Boyle, Martin; Baldwin, Ian

    2010-01-01

    Delivery of renal replacement therapy is now a core competency of intensive care nursing. The safe and effective delivery of this form of therapy is a quality issue for intensive care, requiring an understanding of the principles underlying therapy and the functioning of machines used. Continuous hemofiltration, first described in 1977, used a system where blood flowed from arterial to venous cannulas through a small-volume, low-resistance, and high-flux filter. Monitoring of these early systems was limited, and without a machine interface, less nursing expertise was required. Current continuous renal replacement therapy machines offer user-friendly interfaces, cassette-style circuits, and comprehensive circuit diagnostics and monitoring. Although these machines conceal complexity behind a user-friendly interface, it remains important that nurses have sufficient knowledge for their use and the ability to compare and contrast circuit setups and functions for optimal and efficient treatment.

  2. Renal replacement therapy practices for patients with acute kidney injury in China.

    Science.gov (United States)

    Clark, William R; Ding, Xiaoqiang; Qiu, Haibo; Ni, Zhaohui; Chang, Ping; Fu, Ping; Xu, Jiarui; Wang, MinMin; Yang, Li; Wang, Jing; Ronco, Claudio

    2017-01-01

    Recent data indicate AKI is very common among hospitalized Chinese patients and continuous renal replacement therapy (CRRT) is increasingly offered for treatment. However, only anecdotal information regarding CRRT's use in relation to other modalities and the specific manner in which it is prescribed exists currently. This report summarizes the results of a comprehensive physician survey designed to characterize contemporary dialytic management of AKI patients in China, especially with respect to the utilization of CRRT. The survey queried both nephrologists and critical care physicians across a wide spectrum of hospitals about factors influencing initial RRT modality selection, especially patient clinical characteristics and willingness to receive RRT, treatment location, and institutional capabilities. For patients initially treated with CRRT, data related to indication, timing of treatment initiation, dose, anticoagulation technique, and duration of therapy were also collected. Among AKI patients considered RRT candidates, the survey indicated 15.1% (95% CI, 12.3%-17.9%) did not actually receive dialysis at Chinese hospitals. The finding was largely attributed to prohibitively high therapy costs in the view of patients or their families. The survey confirmed the dichotomy in RRT delivery in China, occurring both in the nephrology department (with nephrologists responsible) and the intensive care unit (with critical care physicians responsible). For all patients who were offered and received RRT, the survey participants reported 63.9% (56.4%-71.3%) were treated initially with CRRT and 24.8% (19.2%-30.3%) with intermittent hemodialysis (HD) (Phr while approximately 20% of prescriptions fell above this range. Daily prescribed therapy duration demonstrated a marked divergence from values reported in the literature and standard clinical practice. Overall, the most common average prescribed value (50% of respondents) fell in the 10-20 hr range, with only 18% in the 20

  3. Risk of fracture in adults on renal replacement therapy

    DEFF Research Database (Denmark)

    Hansen, Ditte; Olesen, Jonas B; Gislason, Gunnar H;

    2016-01-01

    BACKGROUND: Patients on dialysis treatment or living with a transplanted kidney have several risk factors for bone fracture, especially disturbances in mineral metabolism and immunosuppressive therapy. We describe the incidence of fracture in this retrospective national Danish cohort study...... and explore the influence of age, gender, comorbidity and prescribed medication. METHODS: By individual-level linkage between nationwide administrative registries, the risk of fracture was compared between the group of patients receiving chronic dialysis treatment and patients receiving their first renal...... transplanted group: 1.82 (95% CI: 1.62-2.06)]. Prescribed diuretics, lipid-modifying agents and proton pump inhibitors also modulated the fracture risk. CONCLUSIONS: Patients on dialysis or living with a transplanted kidney have a significantly higher risk of fracture than the Danish background population...

  4. Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy.

    Science.gov (United States)

    Ulldemolins, Marta; Vaquer, Sergi; Llauradó-Serra, Mireia; Pontes, Caridad; Calvo, Gonzalo; Soy, Dolors; Martín-Loeches, Ignacio

    2014-06-23

    Although early and appropriate antibiotic therapy remains the most important intervention for successful treatment of septic shock, data guiding optimization of beta-lactam prescription in critically ill patients prescribed with continuous renal replacement therapy (CRRT) are still limited. Being small hydrophilic molecules, beta-lactams are likely to be cleared by CRRT to a significant extent. As a result, additional variability may be introduced to the per se variable antibiotic concentrations in critically ill patients. This article aims to describe the current clinical scenario for beta-lactam dosing in critically ill patients with septic shock and CRRT, to highlight the sources of variability among the different studies that reduce extrapolation to clinical practice, and to identify the opportunities for future research and improvement in this field. Three frequently prescribed beta-lactams (meropenem, piperacillin and ceftriaxone) were chosen for review. Our findings showed that present dosing recommendations are based on studies with drawbacks limiting their applicability in the clinical setting. In general, current antibiotic dosing regimens for CRRT follow a one-size-fits-all fashion despite emerging clinical data suggesting that drug clearance is partially dependent on CRRT modality and intensity. Moreover, some studies pool data from heterogeneous populations with CRRT that may exhibit different pharmacokinetics (for example, admission diagnoses different to septic shock, such as trauma), which also limit their extrapolation to critically ill patients with septic shock. Finally, there is still no consensus regarding the %T>MIC (percentage of dosing interval when concentration of the antibiotic is above the minimum inhibitory concentration of the pathogen) value that should be chosen as the pharmacodynamic target for antibiotic therapy in patients with septic shock and CRRT. For empirically optimized dosing, during the first day a loading dose is required

  5. Continuous renal replacement therapy for acute renal failure in patients with cancer: a well-tolerated adjunct treatment

    Directory of Open Access Journals (Sweden)

    Rebecca Fischler

    2016-08-01

    Full Text Available Abstract Introduction – Acute renal failure (ARF has a poor prognosis in patients with cancer requiring intensive care unit (ICU admission. Our aim is finding prognostic factors for hospital mortality in patients with cancer with ARF requiring renal replacement therapy (RRT. Methods – In this retrospective study, all patients with cancer with ARF treated with continuous venovenous filtration (CVVHDF in the ICU of the Institut Jules Bordet, between January 1st 2003 and December 31st 2012, were included in the study.Results – 103 patients are assessed: men/women 69/34, median age 62 years, solid/haematologic tumours 68/35, median SAPS II 56. Mortality rate was 63%. Seven patients required chronic renal dialysis. After multivariate analysis, two variables were statistically associated with hospital mortality : more than one organ failure (including kidney (OR 5.918 ; 95% CI 2.184 – 16.038 ; p<0,001 and low albumin level (OR 3.341; 95% CI 1.229 – 9.077; p=0,02. Only minor complications related to CVVHDF have been documented.Conclusions – Despite the poor prognosis associated with ARF, CVVHDF is an effective and tolerable renal replacement technique in patients with cancer admitted to the ICU. Multiple organ failure and hypoalbuminemia, two independent prognostic factors for hospital mortality have to be considered when deciding for introducing RRT.

  6. Associations of race and ethnicity with anemia management among patients initiating renal replacement therapy.

    Science.gov (United States)

    Weisbord, Steven D; Fried, Linda F; Mor, Maria K; Resnick, Abby L; Kimmel, Paul L; Palevsky, Paul M; Fine, Michael J

    2007-11-01

    Many patients initiate renal replacement therapy with suboptimal anemia management. The factors contributing to this remain largely unknown. The aim of this study was to assess the associations of race and ethnicity with anemia care prior to the initiation of renal replacement therapy. Using data from the medical evidence form filed for patients who initiated renal replacement therapy between 1995-2003, we assessed racial and ethnic differences in pre-end-stage renal disease hematocrit levels, the use of erythropoiesis stimulation agents (ESAs), the proportion of patients with hematocrit levels > or = 33% and the proportion of patients with hematocrit levels or = 33% (OR = 0.78, 95% CI: 0.77-0.79) or to receive ESA if the hematocrit was or = 33% (OR = 0.91, 95% CI: 0.89-0.93) or to receive ESA if the hematocrit was < 33% (OR = 0.85, 95% CI: 0.83-0.87) than non-Hispanic whites. These disparities persisted over the eight-year study period. African-American race and Hispanic ethnicity are associated with suboptimal pre-end-stage renal disease anemia management. Efforts to improve anemia care should incorporate targeted interventions to decrease these disparities.

  7. High phenobarbital clearance during continuous renal replacement therapy: a case report and pharmacokinetic analysis.

    Science.gov (United States)

    Rosenborg, Staffan; Saraste, Lars; Wide, Katarina

    2014-08-01

    Phenobarbital is an old antiepileptic drug used in severe epilepsy. Despite this, little is written about the need for dose adjustments in renal replacement therapy. Most sources recommend a moderately increased dose guided by therapeutic drug monitoring.A 14 year old boy with nonketotic hyperglycinemia, a rare inborn error of metabolism, characterized by high levels of glycine, epilepsy, spasticity, and cognitive impairment, was admitted to the emergency department with respiratory failure after a few days of fever and cough. The boy was unconscious at admittance and had acute renal and hepatic failure.Due to the acute respiratory infection, hypoxic hepatic and renal failure occurred and the patient had a status epilepticus.The patient was intubated and mechanically ventilated. Continuous renal replacement therapy was initiated. Despite increased phenobarbital doses, therapeutic levels were not reached until the dose was increased to 500 mg twice daily. Therapeutic drug monitoring was performed in plasma and dialysate. Calculations revealed that phenobarbital was almost freely dialyzed.Correct dosing of drugs in patients on renal replacement therapy may need a multidisciplinary approach and guidance by therapeutic drug monitoring.

  8. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

    NARCIS (Netherlands)

    Royakkers, A.A.N.M.; Korevaar, J.C.; van Suijlen, J.D.E.; Hofstra, L.S.; Kuiper, M.A.; Spronk, P.E.; Schultz, M.J.; Bouman, C.S.C.

    2011-01-01

    To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Multicenter prospective observational cohort stu

  9. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy.

    NARCIS (Netherlands)

    Royakkers, A.A.N.M.; Korevaar, J.C.; Suijlen, J.D.E. van; Hofstra, L.S.; Kuiper, M.A.; Spronk, P.E.; Schultz, M.J.; Bouman, C.S.C.

    2011-01-01

    Purpose : To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Methods: Multicenter prospective obser

  10. Demographics of blood pressure and hypertension in children on renal replacement therapy in Europe

    NARCIS (Netherlands)

    A.M. Kramer; K.J. van Stralen; K.J. Jager; F. Schaefer; E. Verrina; T. Seeman; M.A. Lewis; M. Boehm; G.D. Simonetti; G. Novljan; J.W. Groothoff

    2011-01-01

    Hypertension is a well-known complication in children on renal replacement therapy and an important risk factor for cardiovascular disease in later life. In order to define the prevalence of and risk factors for hypertension among children, we enrolled 3337 pediatric patients from 15 countries in th

  11. Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy

    Science.gov (United States)

    Romano, Thiago Gomes; Martins, Cassia Pimenta Barufi; Mendes, Pedro Vitale; Besen, Bruno Adler Maccagnan Pinheiro; Zampieri, Fernando Godinho; Park, Marcelo

    2016-01-01

    Objective The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation. Methods Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations. Results In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values. Conclusions Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose - formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible. PMID:27410407

  12. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy.

    NARCIS (Netherlands)

    Royakkers, A.A.N.M.; Korevaar, J.C.; Suijlen, J.D.E. van; Hofstra, L.S.; Kuiper, M.A.; Spronk, P.E.; Schultz, M.J.; Bouman, C.S.C.

    2011-01-01

    Purpose : To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Methods: Multicenter prospective obser

  13. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

    NARCIS (Netherlands)

    Royakkers, A.A.N.M.; Korevaar, J.C.; van Suijlen, J.D.E.; Hofstra, L.S.; Kuiper, M.A.; Spronk, P.E.; Schultz, M.J.; Bouman, C.S.C.

    2011-01-01

    To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Multicenter prospective observational cohort stu

  14. [The impact of continuous renal replacement therapy training on nursing competence].

    Science.gov (United States)

    Voltzenlogel, Sabine

    2015-06-01

    Specific training adapted to the needs of caregivers in intensive care enables professional competence and quality of care to be developed in continuous renal replacement therapy. In addition, it contributes to reducing the stress felt by caregivers and the costs of this technique. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. Regional and social inequalities in chronic renal replacement therapy in Denmark

    DEFF Research Database (Denmark)

    Hommel, Kristine; Rasmussen, Soren; Kamper, Anne-Lise

    2010-01-01

    Background. The incidence of chronic renal replacement therapy (RRT) varies markedly between Danish nephrology centres. The aim of the present study was to establish if there is regional and social variation in the incidence of chronic RRT in Denmark when analysed according to patient residence...

  16. Pharmacokinetics of cefetaxime in ICU-patients treated with continuous renal replacement : A pilot study

    NARCIS (Netherlands)

    Valk-Swinkels, C.G.H.; Rijpstra, T.A.; Van Der Meer, B.J.M.; Touw, D.J.; van't Veer, N.E.

    2013-01-01

    Introduction: Data on the optimal dosage of cefotaxime (CTX) in patients receiving continuous renal replacement therapy (CRRT) is sparse and equivocal [1]. We conducted a trial investigating the concentrations of CTX in general ICU and post-cardiac surgery ICU patients who were treated with CRRT bec

  17. Acute dialysis and continuous renal replacement: the emergence of new technology involving the nephrologist in the intensive care setting.

    Science.gov (United States)

    Yagi, N; Paganini, E P

    1997-07-01

    The emergence of dialytic support for patients with reversible renal failure was one of the most significant advances in critical care medicine. Supporting a patient with a failed organ till organ recovery has not had the same success with other organ failures. Despite the indispensable nature of the support, dialysis was intermittent at best, and carried its own morbidity. The emergence of a "continuous" dialysis delivery system, originally through an arteriovenous access and later through veno-venous methodology, began to simulate the continuity of the natural kidney, and lifted much of the fluid and drug restrictions imposed by the intermittent nature of standard dialytic therapies. Components of the system were next reviewed for improvement and biocompatability. Differences in patient outcome were documented with various component comparisons, and disparate patient tolerance of delivery modality was also clearly proven. The hemodynamic stability of continuous treatment created utilization to be focused on the more unstable, the more severely compromised patient group. In this context, comparative studies with intermittent delivery methods showed improved hemodynamic stability among patients treated with continuous renal replacement therapies (CRRT), but no clear difference in patient mortality. Patient characteristics and severity scoring have recently been undertaken to better describe the population, and attempts at dialysis dosing is currently being developed for ARF dialysis recipients. Early results seem to point toward a dialysis dose effect on mortality in certain groups of ICU acute renal failure patients. However, the dialytic process is only depurative and artificial. Plastic membrane bio-incompatibility, human physiological responses to foreign material exposure, either in the circuit material itself or introduced from therapy methodology, pose practical and theoretical problems. Recent advances in the field of bio-artificial technology have allowed

  18. Using Modality Replacement to Facilitate Communication between Visually and Hearing-Impaired People

    DEFF Research Database (Denmark)

    Moustakas, K.; Tzovaras, D.; Dybkjaer, L.

    2011-01-01

    Using sign language, speech, and haptics as communication modalities, a virtual treasure-hunting game serves as an entertainment and educational tool for visually-and hearing-impaired users.......Using sign language, speech, and haptics as communication modalities, a virtual treasure-hunting game serves as an entertainment and educational tool for visually-and hearing-impaired users....

  19. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

    Directory of Open Access Journals (Sweden)

    Silviu Grisaru

    2011-01-01

    Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.

  20. Evaluation of the hemodynamic impact of continuous renal replacement therapy in healthy dogs.

    Science.gov (United States)

    Shimokawa Miyama, Takako; Itamoto, Kazuhito; Yoshioka, Chihiro; Minami, Koji; Okawa, Takumi; Fujisaki, Yuka; Hiraoka, Hiroko; Mizuno, Takuya; Okuda, Masaru

    2010-04-01

    We performed continuous renal replacement therapy (CRRT) on clinically healthy dogs to evaluate the effects of CRRT on hemodynamics. Heart rate, arterial blood pressure, and central venous pressure of the dogs (n=6) were recorded during the procedure, which was performed under general anesthesia. Throughout the CRRT, heart rate and arterial blood pressure were stable. Central venous pressure increased after CRRT termination but returned to the basal level within 30 min. In this study, hemodynamic alterations, including hypotension, hypertension, and arrhythmias, were not observed during CRRT. These observations suggest that the CRRT protocol used in the present study can be safely applied to clinical cases with acute renal failure.

  1. Evaluating the quality of patient leaflets about renal replacement therapy across UK renal units.

    Science.gov (United States)

    Winterbottom, Anna; Conner, Mark; Mooney, Andrew; Bekker, Hilary L

    2007-08-01

    Enhancing patient participation is a priority for renal services. Good quality information is fundamental to facilitate patient involvement, but in other health contexts it has been found to be sub-optimal. This research aims to audit the provision of patient information by renal units and charities and to assess the quality of written information about dialysis treatment options. All UK renal units were sent a questionnaire about the patient information they provided. Renal units and charities that provided dialysis leaflets were asked to forward copies. Leaflet quality and content were assessed by a coding frame informed by information and decision aid checklists. Out of 105, 67 completed questionnaires were returned. Services provide patients with large amounts of information in several media (leaflets, meetings with nurses and patients, videos); computers were not used frequently. Out of 47, 32 units forwarded leaflets about dialysis, and 31 different leaflets. Most leaflets were difficult to understand and rarely included risk information or treatment limitations. No leaflets included techniques to assist patient involvement or decision-making; their primary goal was to inform. These data suggest an unsystematic pattern of information provision across the UK. Vast resources have been spent on providing information to patients that is difficult to comprehend and incomplete. Research needs to identify which resources are effective in meeting patient needs and at what point in their illness. A centralized system to guide renal services in the design and development of information resources may help meet the differing goals of education, choice facilitation and preparation for self-management.

  2. Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report

    Science.gov (United States)

    Pippias, Maria; Stel, Vianda S.; Abad Diez, José Maria; Afentakis, Nikolaos; Herrero-Calvo, Jose Antonio; Arias, Manuel; Tomilina, Natalia; Bouzas Caamaño, Encarnación; Buturovic-Ponikvar, Jadranka; Čala, Svjetlana; Caskey, Fergus J.; Castro de la Nuez, Pablo; Cernevskis, Harijs; Collart, Frederic; Alonso de la Torre, Ramón; García Bazaga, Maria de los Ángeles; De Meester, Johan; Díaz, Joan Manuel; Djukanovic, Ljubica; Ferrer Alamar, Manuel; Finne, Patrik; Garneata, Liliana; Golan, Eliezer; González Fernández, Raquel; Gutiérrez Avila, Gonzalo; Heaf, James; Hoitsma, Andries; Kantaria, Nino; Kolesnyk, Mykola; Kramar, Reinhard; Kramer, Anneke; Lassalle, Mathilde; Leivestad, Torbjørn; Lopot, Frantisek; Macário, Fernando; Magaz, Angela; Martín-Escobar, Eduardo; Metcalfe, Wendy; Noordzij, Marlies; Palsson, Runolfur; Pechter, Ülle; Prütz, Karl G.; Ratkovic, Marina; Resić, Halima; Rutkowski, Boleslaw; Santiuste de Pablos, Carmen; Spustová, Viera; Süleymanlar, Gültekin; Van Stralen, Karlijn; Thereska, Nestor; Wanner, Christoph; Jager, Kitty J.

    2015-01-01

    Background This article summarizes the 2012 European Renal Association—European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years). Methods Data provided by 45 national or regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. Individual patient level data were received from 31 renal registries, whereas 14 renal registries contributed data in an aggregated form. The incidence, prevalence and survival probabilities of patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT) and renal transplantation rates for 2012 are presented. Results In 2012, the overall unadjusted incidence rate of patients with ESRD receiving RRT was 109.6 per million population (pmp) (n = 69 035), ranging from 219.9 pmp in Portugal to 24.2 pmp in Montenegro. The proportion of incident patients ≥75 years varied from 15 to 44% between countries. The overall unadjusted prevalence on 31 December 2012 was 716.7 pmp (n = 451 270), ranging from 1670.2 pmp in Portugal to 146.7 pmp in the Ukraine. The proportion of prevalent patients ≥75 years varied from 11 to 32% between countries. The overall renal transplantation rate in 2012 was 28.3 pmp (n = 15 673), with the highest rate seen in the Spanish region of Catalonia. The proportion of patients ≥65 years receiving a transplant ranged from 0 to 35%. Five-year adjusted survival for all RRT patients was 59.7% (95% confidence interval, CI: 59.3–60.0) which fell to 39.3% (95% CI: 38.7–39.9) in patients 65–74 years and 21.3% (95% CI: 20.8–21.9) in patients ≥75 years. PMID:26034584

  3. Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Faulhaber-Walter R

    2016-05-01

    Full Text Available Robert Faulhaber-Walter,1,2 Sebastian Scholz,1,3 Herrmann Haller,1 Jan T Kielstein,1,* Carsten Hafer1,4,* 1Department of Renal and Hypertensive Disease, Medical School Hannover, Hannover, Germany; 2Facharztzentrum Aarberg, Waldshut-Tiengen, Germany; 3Sanitaetsversorgungszentrum Wunstorf, Wunstorf, Germany; 4HELIOS Klinikum Erfurt, Erfurt, Germany *These authors contributed equally to this work Background: Critically ill patients with acute kidney injury (AKI in need of renal replacement therapy (RRT may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated. Study design: Survivors of the HANnover Dialysis OUTcome (HANDOUT study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL. The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure. Results: One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital. Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72.5±30 mL/min/1.73 m2; mean proteinuria 89±84 mg/d. One person required maintenance dialysis. Seventy-nine percent of the patients had a pathological kidney sonomorphology. The Charlson comorbidity score was 2.2±1.4 and adjusted for age 3.3±2.1 years. Numbers of comorbid conditions averaged 2.38±1.72 per patient (heart failure [52%] > chronic kidney disease/myocardial infarction [each 29%]. Median 36-item short form health survey (SF-36™ index was 0.657 (0.69 physical health/0.66 mental health. Quality-adjusted life-years after 5 years were 3.365. Conclusion: Mortality after severe AKI is higher than

  4. Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center.

    Science.gov (United States)

    Ridão Curty, Natália Fabiane; da Silva Martins, Lucilene Fagundes; Sanches Ito, Carmen Antônia; Schafranski, Marcelo; Brites, Dorelayne Aparecida; Busato, César Roberto

    2014-01-01

    Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95%=2.13-5.17; p=0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p=0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p=0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  5. Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation

    DEFF Research Database (Denmark)

    Fosbøl, Emil L; Kamper, Anne-Lise; Køber, Lars;

    2012-01-01

    PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with severe renal complications, including acute renal failure, reduced glomerular filtration rate and interstitial nephritis. Caution against NSAIDs is therefore recommended in advanced chronic kidney disease. In this study......, we examined NSAID use, aetiology and comorbidity among a national cohort of patients before the initiation of chronic renal replacement therapy (RRT). METHODS: Patients initiated on chronic RRT in the period 1997-2006 were identified in the Danish National Registry on Regular Dialysis...... and Transplantation, including etiological diagnosis. The use of NSAID before the start of RRT was studied by linkage to the National Prescription Register and comorbidity by linkage to the National Patient Registry. RESULTS: A total of 6663 patients were included in the study, and 2407 patients (36.1%) were...

  6. Effects of continuous renal replacement therapy on linezolid pharmacokinetic/pharmacodynamics: a systematic review

    OpenAIRE

    Villa, Gianluca; Di Maggio, Paola; De Gaudio, A Raffaele; Novelli, Andrea; Antoniotti, Riccardo; Fiaccadori, Enrico; Adembri, Chiara

    2016-01-01

    Background Major alterations in linezolid pharmacokinetic/pharmacodynamic (PK/PD) parameters might be expected in critically ill septic patients with acute kidney injury (AKI) who are undergoing continuous renal replacement therapy (CRRT). The present review is aimed at describing extracorporeal removal of linezolid and the main PK-PD parameter changes observed in critically ill septic patients with AKI, who are on CRRT. Method Citations published on PubMed up to January 2016 were systematica...

  7. Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies

    OpenAIRE

    Anna P. Kempke; Leino, Abbie S.; Farzad Daneshvar; John Andrew Lee; Mueller, Bruce A.

    2016-01-01

    Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic dat...

  8. Pharmacokinetics of Procainamide and N-acetylprocainamide during Continuous Renal Replacement Therapy

    OpenAIRE

    Mohamed, Ahmed N.; Abdelhady, Ahmed M.; Spencer, Dustin; Sowinski, Kevin M.; Tisdale, James E; Overholser, Brian R.

    2013-01-01

    Procainamide and its major metabolite, N-acetyl procainamide (NAPA), prolong the QTc interval and can promote potentially fatal ventricular arrhythmias. Excretion of procainamide and NAPA is reduced in patients with chronic kidney disease (CKD) resulting in drug accumulation and toxicity. The elimination of procainamide or NAPA in patients undergoing continuous renal replacement therapy (CRRT) has not been evaluated increasing the risk for subtherapeutic or toxic dosing regimens. This case re...

  9. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy

    OpenAIRE

    Xu, Xiaoying; Khadzhynov, Dmytro; Peters, Harm; Chaves, Ricardo L.; Hamed, Kamal; Levi, Micha; Corti, Natascia

    2016-01-01

    Aim The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). Methods A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno?venous haemodialysis (CVVHD; n?=?9) and continuous veno?venous haemodiafiltration (CVVHDF; n?=?8). Model?based simulations were performed to compare the 24?h AUC, C max an...

  10. Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy

    OpenAIRE

    Ulldemolins, Marta; Vaquer, Sergi; Llauradó-Serra, Mireia; Pontes, Caridad; Calvo, Gonzalo; Soy, Dolors; Martín-Loeches, Ignacio

    2014-01-01

    Although early and appropriate antibiotic therapy remains the most important intervention for successful treatment of septic shock, data guiding optimization of beta-lactam prescription in critically ill patients prescribed with continuous renal replacement therapy (CRRT) are still limited. Being small hydrophilic molecules, beta-lactams are likely to be cleared by CRRT to a significant extent. As a result, additional variability may be introduced to the per se variable antibiotic concentrati...

  11. ACD-A solution as anticoagulant during continuous renal replacement therapy in high risk bleeding patients

    Institute of Scientific and Technical Information of China (English)

    杨松涛

    2014-01-01

    Objective To assess the efficacy and safety of ACDA solution as anticoagulant during continuous renal replacement therapy(CRRT)in high risk of bleeding patients.Methods Forty high risk bleeding patients on continuous veno-venous hemofiltration(CVVH)were randomly divided into two groups:ACD-A group(22 patients,61 cases)and heparin-free group(18 patients,47cases).Serum creatinine,function of the coagulation

  12. Therapeutic efficiency of continuous renal replacement therapy--experience of a single Romanian center.

    Science.gov (United States)

    Voiculescu, M; Ionescu, Camelia; Ismail, G; Roşu, Mihaela; Szigeti, A; Iliescu, Olguţa

    2004-01-01

    We have studied 24 patients with acute renal failure (ARF) or acutization of chronic renal failure (CRF) caused by a variety of different disorders. A rapid decline in renal excretory function, fluid, electrolyte, and divalent ion disturbances determined us to initiate continuous renal replacement: continuous venovenous hemofiltration (CVVHF)--28 procedures in 15 patients and continuous venovenous hemodiafiltration (CVVHDF)--11 procedures in 11 patients. Mean duration of CVVHF was 21.6+/-6.9 h, with a mean blood flow rate of 116.9+/-16.4 ml/min and an ultrafiltration rate of 6.4+/-4.6 ml/min. Serum creatinine level decreased from 12.6 to 8.3 mg% and the concentration of urea from 237 to 166 mg%. Mean duration of hemodiafiltration was 24+/-8.5 h, with mean blood flow rate of 134+/-15.2 ml/min, mean dialysate flow of 35+/-7 ml/min and mean ultrafiltration rate of 5.6+/-2.1 ml/min. Serum creatinine level decreased from 11.6 to 6.36 mg% and the concentration of urea from 236 to 137 mg%. Survival rate was 79.2% (19/24 patients). Complete recover of renal function was achieved in 5 patients, partial recover in 5 patients and 9 patients were included in chronic dialysis. In 8/24 (30%) patients we encountered complications, such as hypotension in 2 cases, bleeding disorders in 5 cases or diselectrolithemias in 2 cases. As a consequence, continuous renal replacement therapy is efficient, having an acceptable rate of adverse effects in patients with ARF or acutization of CRF.

  13. Quantifying the benefit of early living-donor renal transplantation with a simulation model of the Dutch renal replacement therapy population.

    NARCIS (Netherlands)

    Liem, Y.S.; Wong, J.B.; Winkelmayer, W.C.; Weimar, W.; Wetzels, J.F.M.; Charro, F.T. de; Kaandorp, G.C.; Stijnen, T.; Hunink, M.G.M.

    2012-01-01

    BACKGROUND: Early living-donor transplantation improves patient- and graft-survival compared with possible cadaveric renal transplantation (RTx), but the magnitude of the survival gain is unknown. For patients starting renal replacement therapy (RRT), we aimed to quantify the survival benefit of ear

  14. Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

    Directory of Open Access Journals (Sweden)

    Lehmann Petra

    2012-07-01

    Full Text Available Abstract Background Long term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades. Methods Single center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed. Results 964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p  Discussion We document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population. Conclusions Survival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.

  15. Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators.

    Science.gov (United States)

    van de Luijtgaarden, Moniek W M; Jager, Kitty J; Stel, Vianda S; Kramer, Anneke; Cusumano, Ana; Elliott, Robert F; Geue, Claudia; MacLeod, Alison M; Stengel, Benedicte; Covic, Adrian; Caskey, Fergus J

    2013-05-01

    An increase in the dialysis programme expenditure is expected in most countries given the continued rise in the number of people with end-stage renal disease (ESRD) globally. Since chronic peritoneal dialysis (PD) therapy is relatively less expensive compared with haemodialysis (HD) and because there is no survival difference between PD and HD, identifying factors associated with PD use is important. Incidence counts for the years 2003-05 were available from 36 countries worldwide. We studied associations of population characteristics, macroeconomic factors and renal service indicators with the percentage of patients on PD at Day 91 after starting dialysis. With linear regression models, we obtained relative risks (RRs) with 95% confidence intervals (CIs). The median percentage of incident patients on PD was 12% (interquartile range: 7-26%). Determinants independently associated with lower percentages of patients on PD were as follows: patients with diabetic kidney disease (per 5% increase) (RR 0.93; 95% CI 0.89-0.97), health expenditure as % gross domestic product (per 1% increase) (RR 0.93; 95% CI 0.87-0.98), private-for-profit share of HD facilities (per 1% increase) (RR 0.996; 95% CI 0.99-1.00; P = 0.04), costs of PD consumables relative to staffing (per 0.1 increase) (RR 0.97; 95% CI 0.95-0.99). The factors associated with a lower percentage of patients on PD include higher diabetes prevalence, higher healthcare expenditures, larger share of private-for-profit centres and higher costs of PD consumables relative to staffing. Whether dialysis modality mix can be influenced by changing healthcare organization and funding requires additional studies.

  16. The challenges of renal replacement therapy and renal palliative care in the elderly.

    Science.gov (United States)

    Isles, C; Robertson, S; Almond, A; Donaldson, K; Clark, D

    2011-09-01

    The main aim of this review is to let general practitioners and physicians understand what happens to older patients after referral to the renal service. Usually, most patients will be managed completely by the renal team, either because the patient requires dialysis or because conservative but specialised care is appropriate. The recent increase in dialysis rate can mostly be accounted for by older patients for whom such demanding treatment was previously thought to be contraindicated. The decision to dialyse the elderly still remains difficult, with recent data suggesting that if there are significant comorbidities the survival advantage of dialysis in patients over 75 years of age is unlikely to be more than four months. Towards the end of life, conservative treatment is not simply a decision not to dialyse, but comprises active disease management, including treatment of anaemia and other supportive care, which may become increasingly complex, e.g. pain relief with fentanyl and alfentanyl. Older patients who decide to accept dialysis treatment contend with all the usual end of life issues of older people. They have an additional option, denied to the rest of us, of dialysis withdrawal; this effectively allows them to die at a time of their choosing.

  17. Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial.

    Science.gov (United States)

    Lins, Robert L; Elseviers, Monique M; Van der Niepen, Patricia; Hoste, Eric; Malbrain, Manu L; Damas, Pierre; Devriendt, Jacques

    2009-02-01

    There is uncertainty on the effect of different dialysis modalities for the treatment of patients with acute kidney injury (AKI), admitted to the intensive care unit (ICU). This controlled clinical trial performed in the framework of the multicentre SHARF 4 study (Stuivenberg Hospital Acute Renal Failure) aimed to investigate the outcome in patients with AKI, stratified according to severity of disease and randomized to different treatment options. This was a multicentre prospective randomized controlled trial with stratification according to severity of disease expressed by the SHARF score. ICU patients were eligible for inclusion when serum creatinine was >2 mg/dL, and RRT was initiated. The selected patients were randomized to intermittent (IRRT) or continuous renal replacement therapy (CRRT). A total of 316 AKI patients were randomly assigned to IRRT (n = 144) or CRRT (n = 172). The mean age was 66 (range 18-96); 59% were male. Intention-to-treat analysis revealed a mortality of 62.5% in IRRT compared to 58.1% in CRRT (P = 0.430). No difference between IRRT and CRRT could be observed in the duration of ICU stay or hospital stay. In survivors, renal recovery at hospital discharge was comparable between both groups. Multivariate analysis, including the SHARF score, APACHE II and SOFA scores for correction of disease severity, showed no difference in mortality between both treatment modalities. This result was confirmed in pre-specified subgroup analysis (elderly, patients with sepsis, heart failure, ventilation) and after exclusion of possible confounders (early mortality, delayed ICU admission). Modality of RRT, either CRRT or IRRT, had no impact on the outcome in ICU patients with AKI. Both modalities need to be considered as complementary in the treatment of AKI (Clinical Trial: SHARF 4, NCT00322933, http://ClinicalTrials.gov).

  18. An update on renal replacement therapy in Europe: ERA-EDTA Registry data from 1997 to 2006

    DEFF Research Database (Denmark)

    Kramer, Anneke; Stel, Vianda; Zoccali, Carmine;

    2009-01-01

    BACKGROUND: Recent studies have indicated a stabilization in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in a number of European countries. The aim of this study was to provide an update on the incidence, prevalence and outcomes of RRT in Europe over ...

  19. An update on renal replacement therapy in Europe: ERA-EDTA Registry data from 1997 to 2006

    NARCIS (Netherlands)

    A. Kramer; V. Stel; C. Zoccali; J. Heaf; D. Ansell; C. Grönhagen-Riska; T. Leivestad; K. Simpson; R. Pálsson; M. Postorino; K. Jager

    2009-01-01

    Background. Recent studies have indicated a stabilization in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in a number of European countries. The aim of this study was to provide an update on the incidence, prevalence and outcomes of RRT in Europe over the

  20. [Pharmacokinetic principles and drug-dosing adjustments during continuous renal replacement therapies (CRRT)].

    Science.gov (United States)

    Morabito, S; Guzzo, I; Vitaliano, E; Muzi, L; Solazzo, A; Pistolesi, V; Pierucci, A

    2006-01-01

    In the critically ill, acute renal failure (ARF) and "Multiple Organ Dysfunction Syndrome" (MODS) can be associated with significant modifications of many pharmacokinetic parameters, such as protein binding, volume of distribution and total body clearance. The start of renal replacement therapy (RRT) represents an additional variable to take in consideration for drug-dosing adjustments. Drugs significantly eliminated by the kidney are likely to be removed during RRT and a supplemental dose or further dosing adjustments are required if extracorporeal clearance is more than 25-30% of total body clearance. The impact of RRT on plasma drug concentrations can be substantially different in relation to the type of treatment (diffusive, convective or both), membrane characteristics (low-flux or high-flux), filter surface area and prescribed dialysis dose. The molecular weight cut-offs of high-flux membrane are much higher than the molecular weight of most drugs. Therefore, molecular size will not be a limitation for the removal of the unbound fraction of the drugs most commonly used in the critically ill undergoing continuous renal replacement therapy (CRRT). However, diffusive clearance could be significantly lower than convective clearance for drugs in the middle molecular weight range. In any case, the extracorporeal clearances report-ed with the use of high-volume CRRT (>50-60 L/2 h) are often surprisingly elevated and can lead to drug underdosing in clinical conditions where adequate antibiotic treatment is essential.

  1. Renal replacement therapy in Europe: a summary of the 2011 ERA–EDTA Registry Annual Report

    Science.gov (United States)

    Noordzij, Marlies; Kramer, Anneke; Abad Diez, José M.; Alonso de la Torre, Ramón; Arcos Fuster, Emma; Bikbov, Boris T.; Bonthuis, Marjolein; Bouzas Caamaño, Encarnación; Čala, Svetlana; Caskey, Fergus J.; Castro de la Nuez, Pablo; Cernevskis, Harijs; Collart, Frederic; Díaz Tejeiro, Rafael; Djukanovic, Ljubica; Ferrer-Alamar, Manuel; Finne, Patrik; García Bazaga, María de los Angelos; Garneata, Liliana; Golan, Eliezer; Gonzalez Fernández, Raquel; Heaf, James G.; Hoitsma, Andries; Ioannidis, George A.; Kolesnyk, Mykola; Kramar, Reinhard; Lasalle, Mathilde; Leivestad, Torbjørn; Lopot, Frantisek; van de Luijtgaarden, Moniek W.M.; Macário, Fernando; Magaz, Ángela; Martín Escobar, Eduardo; de Meester, Johan; Metcalfe, Wendy; Ots-Rosenberg, Mai; Palsson, Runolfur; Piñera, Celestino; Pippias, Maria; Prütz, Karl G.; Ratkovic, Marina; Resić, Halima; Rodríguez Hernández, Aurelio; Rutkowski, Boleslaw; Spustová, Viera; Stel, Vianda S.; Stojceva-Taneva, Olivera; Süleymanlar, Gültekin; Wanner, Christoph; Jager, Kitty J.

    2014-01-01

    Background This article provides a summary of the 2011 ERA–EDTA Registry Annual Report (available at www.era-edta-reg.org). Methods Data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) from national and regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. From 27 registries, individual patient data were received, whereas 17 registries contributed data in aggregated form. We present the incidence and prevalence of RRT, and renal transplant rates in 2011. In addition, survival probabilities and expected remaining lifetimes were calculated for those registries providing individual patient data. Results The overall unadjusted incidence rate of RRT in 2011 among all registries reporting to the ERA–EDTA Registry was 117 per million population (pmp) (n = 71.631). Incidence rates varied from 24 pmp in Ukraine to 238 pmp in Turkey. The overall unadjusted prevalence of RRT for ESRD on 31 December 2011 was 692 pmp (n = 425 824). The highest prevalence was reported by Portugal (1662 pmp) and the lowest by Ukraine (131 pmp). Among all registries, a total of 22 814 renal transplantations were performed (37 pmp). The highest overall transplant rate was reported from Spain, Cantabria (81 pmp), whereas the highest rate of living donor transplants was reported from Turkey (39 pmp). For patients who started RRT between 2002 and 2006, the unadjusted 5-year patient survival on RRT was 46.8% [95% confidence interval (CI) 46.6–47.0], and on dialysis 39.3% (95% CI 39.2–39.4). The unadjusted 5-year patient survival after the first renal transplantation performed between 2002 and 2006 was 86.7% (95% CI 86.2–87.2) for kidneys from deceased donors and 94.3% (95% CI 93.6–95.0) for kidneys from living donors. PMID:25852881

  2. Update on Renal Replacement Therapy: Implantable Artificial Devices and Bioengineered Organs.

    Science.gov (United States)

    Attanasio, Chiara; Latancia, Marcela T; Otterbein, Leo E; Netti, Paolo A

    2016-08-01

    Recent advances in the fields of artificial organs and regenerative medicine are now joining forces in the areas of organ transplantation and bioengineering to solve continued challenges for patients with end-stage renal disease. The waiting lists for those needing a transplant continue to exceed demand. Dialysis, while effective, brings different challenges, including quality of life and susceptibility to infection. Unfortunately, the majority of research outputs are far from delivering satisfactory solutions. Current efforts are focused on providing a self-standing device able to recapitulate kidney function. In this review, we focus on two remarkable innovations that may offer significant clinical impact in the field of renal replacement therapy: the implantable artificial renal assist device (RAD) and the transplantable bioengineered kidney. The artificial RAD strategy utilizes micromachining techniques to fabricate a biohybrid system able to mimic renal morphology and function. The current trend in kidney bioengineering exploits the structure of the native organ to produce a kidney that is ready to be transplanted. Although these two systems stem from different technological approaches, they are both designed to be implantable, long lasting, and free standing to allow patients with kidney failure to be autonomous. However, for both of them, there are relevant issues that must be addressed before translation into clinical use and these are discussed in this review.

  3. [Long-term outcomes of children treated with continuous renal replacement therapy].

    Science.gov (United States)

    Almarza, S; Bialobrzeska, K; Casellas, M M; Santiago, M J; López-Herce, J; Toledo, B; Carrillo, Á

    2015-12-01

    The objective of this study is to analyze long-term outcomes and kidney function in children requiring continuous renal replacement therapy (CRRT) after an acute kidney injury episode. A retrospective observational study was performed using a prospective database of 128 patients who required CRRT admitted to the pediatric intensive care unit between years 2006 and 2012. The subsequent outcomes were assessed in those surviving at hospital discharge. Of the 128 children who required RRT in the pediatric intensive care unit, 71 survived at hospital discharge (54.4%), of whom 66 (92.9%) were followed up. Three patients had chronic renal failure prior to admission to the NICU. Of the 63 remaining patients, 6 had prolonged or relapses of renal function disturbances, but only one patient with atypical Hemolytic Uremic Syndrome developed end-stage renal failure. The rest had normal kidney function at the last check-up. Most of surviving children that required CRRT have a positive outcome later on, presenting low mortality rates and recovery of kidney function in the medium term. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  4. Fatal pulmonary embolism following elective total knee replacement using aspirin in multi-modal prophylaxis - A 12year study.

    Science.gov (United States)

    Quah, C; Bayley, E; Bhamber, N; Howard, P

    2017-06-13

    The National Institute for Health and Clinical Excellence (NICE) has issued guidelines on which thromboprophylaxis regimens are suitable following lower limb arthroplasty. Aspirin is not a recommended agent despite being accepted in orthopaedic guidelines elsewhere. We assessed the incidence of fatal pulmonary embolism (PE) and all-cause mortality following elective primary total knee replacement (TKR) with a standardised multi-modal prophylaxis regime in a large teaching district general hospital. We utilised a prospective audit database to identify those that had died within 42 and 90days postoperatively. Data from April 2000 to 2012 were analysed for 42 and 90day mortality rates. There were a total of 8277 elective primary TKR performed over the 12year period. The multi-modal prophylaxis regimen used unless contraindicated for all patients included 75mg aspirin once daily for four weeks. Case note review ascertained the causes of death. Where a patient had been referred to the coroner, they were contacted for post mortem results. The mortality rates at 42 and 90days were 0.36 and 0.46%. There was one fatal PE within 42days of surgery (0.01%) who was taking enoxaparin because of aspirin intolerance. Two fatal PE's occurred at 48 and 57days post-operatively (0.02%). The leading cause of death was myocardial infarction (0.13%). Fatal PE following elective TKR with a multi-modal prophylaxis regime is a very rare cause of mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis.

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    Chesnaye, Nicholas C; Schaefer, Franz; Bonthuis, Marjolein; Holman, Rebecca; Baiko, Sergey; Baskın, Esra; Bjerre, Anna; Cloarec, Sylvie; Cornelissen, Elisabeth A M; Espinosa, Laura; Heaf, James; Stone, Rosário; Shtiza, Diamant; Zagozdzon, Ilona; Harambat, Jérôme; Jager, Kitty J; Groothoff, Jaap W; van Stralen, Karlijn J

    2017-05-27

    We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15·8 deaths per 1000 patient-years (IQR 6·4-16·4). France had a mortality rate (9·2) of more than 3 SDs better, and Russia (35·2), Poland (39·9), Romania (47·4), and Bulgaria (68·6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0·69, 95% CI 0·52-0·91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1·31 [95% CI 1·13-1·53], p=0·0005, to 1·21 [0·97-1·51], p=0·10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and

  6. Funding renal replacement therapy in southeast Asia: building public-private partnerships in Singapore, Malaysia, Thailand, and Indonesia.

    Science.gov (United States)

    Morad, Zaki; Choong, Hui Lin; Tungsanga, Kriang; Suhardjono

    2015-05-01

    The provision of renal replacement therapy (RRT) in developing economies is limited by lack of financial and other resources. There are no national reimbursement policies for RRT in many countries in Asia. The Southeast Asia countries of Singapore, Malaysia, Thailand, and Indonesia have adopted a strategy of encouraging public-private partnerships to increase the RRT rates in their respective countries. The private organizations include both for-profit and philanthropic bodies. The latter raise funds from ordinary citizens, corporations, and faith-based groups, as well as receive subsidies from the government to support RRT for patients in need. The kidney foundations of these countries play a leadership role in this public-private partnership. Many of the private organizations that support RRT are providers of treatment in addition to offering financial assistance to patients, with hemodialysis being the most frequently supported modality. Public-private partnership in funding RRT is sustainable over the long term with proper organization and facilitated by support from the government. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  7. Stage progression and need for renal replacement therapy in a renal protection programme in Colombia. A cohort study.

    Science.gov (United States)

    Yepes Delgado, Carlos Enrique; Pérez Dávila, Sara; Montoya Jaramillo, Marcela; Orrego Orozco, Beatriz Elena

    Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). An analytical study that monitored 2cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  8. [Aluminium in chronic renal replacement therapy patients undergoing haemodialysis in two renal units in Bogotá].

    Science.gov (United States)

    Cárdenas, Omayda; Segura, Omar; Puentes, William; Sanabria, Mauricio; Nava, Gerardo; Torrenegra, Rubén

    2010-08-01

    Determining aluminium concentrations in the serum of patients undergoing chronic renal replacement therapy with haemodialysis and concentration in distribution network water and dialysis in two renal units in Bogotá. This was a descriptive study of 63 haemodialysed patients and 20 healthy subjects. Aluminium concentration was determined in water and serum using graphite furnace atomic absorption spectrometry with deuterium lamp background corrector. Average aluminium concentration was 26.5 µg/L in patients (ranging from 11.2 to 49.2 µg/L; 8.03 standard deviation) and 8.05 µg/L in healthy individuals (ranging from undetectable to 17.2 µg/L; 4.31 standard deviation). Aluminium concentration in dialysis water and distribution network water was below 2 µg/L and 200 µg/L, respectively. Aluminium concentration in water and serum in this study was below international standard values, thereby indicating appropriate treatment. Additionally, aluminium concentration in pre-HD and post-HD sera was below that reported previously. Aluminium hydroxide uptake increases aluminium concentration in serum. Personal situation regarding age, gender, civil and work status were not risk factors determining aluminium concentrations in serum.

  9. Long term end-stage renal disease and death following acute renal replacement therapy in the ICU

    DEFF Research Database (Denmark)

    Lohse, R.; Damholt, M. B.; Wiis, J.

    2016-01-01

    INTRODUCTION: In ICU the need for acute renal replacement therapy (RRT) associates with high mortality and risk of end-stage renal disease (ESRD), but there are limited long-term data. We investigated these outcomes and their risk factors. METHODS: Retrospective analysis of all adult patients...... admitted to a general, university hospital ICU 2005-2012, excluding chronic dialysis patients. ESRD was defined as need of RRT > 90 days or kidney transplant. RESULTS: Of 5766 patients included, 1004 (16%) received acute RRT; their 30-day mortality was 42% vs. 16% for those not requiring acute RRT...... (adjusted hazard ratio (HR) 1.13 (0.96-1.32)). The 90-day mortality was 55% for patients receiving acute RRT vs. 22% for those who did not (adjusted HR 1.32 (1.15-1.51)) and 1-year mortality was 63% vs. 30%, respectively, (adjusted HR 1.31 (1.16-1.48)). The 7-year risk of ESRD for ICU patients surviving 90...

  10. [Concentration of fluoride in mixed saliva of patients with end-stage renal disease undergoing renal replacement therapy].

    Science.gov (United States)

    Gorbaczewski, Andrzej; Buczkowska-Radlińska, Jadwiga; Chlubek, Dariusz; Noceń, Iwona; Samujło, Dorota; Trusewicz, Matylda

    2004-01-01

    This study was carried out on 48 patients with ESRD undergoing hemodialysis treatment (29 males and 19 females, mean age 50.8 years) and renal transplantation (15 females and 33 males, mean age 42.2 years). The results were compared with a group of 44 healthy persons (23 females and 21 males, mean age 49.5 years). The aim of our investigation was to examine the content of fluoride in the mixed unstimulated saliva of the patients undergoing renal replacement therapy and in the control group of healthy persons. We studied the influence of hemodialysis on saliva fluoride levels. Saliva samples were collected by the spitting method according to Navazesh. Samples were collected before and after hemodialysis session and once in graft recipients and controls. Fluoride concentrations were determined with an Orion fluoroselective electrode model 96-09. The fluoride level in healthy persons was 4.92 +/- 2.30 micromol/L. Before hemodialysis, the mean fluoride level was 9.63 +/- 3.90 micromol/L and decreased significantly to 7.52 +/- 2.71 micromol/L after hemodialysis (p < 0.0001). Saliva content of fluorides in patients before and after hemodialysis was significantly higher than in healthy subjects and kidney graft recipients (p < 0.0001). There was no significant difference in fluoride concentration between patients after kidney transplantation and controls. The results suggest the need for individual fluoride supplementation in chronically hemodialysed patients.

  11. Understanding renal replacement therapy and dosing of drugs in pediatric patients with kidney disease.

    Science.gov (United States)

    Zuppa, Athena F

    2012-01-01

    Multifaceted factors need to be considered when prescribing renal replacement therapy (RRT) and dosing of drugs in pediatric patients with kidney disease. RRTs in pediatrics such as intermittent hemodialysis, continuous venovenous hemofiltration, continuous venovenous hemodialysis, and continuous venovenous hemodiafiltration affect solute and drug clearance. Drug properties such as molecular weight, molecular charge, volume of distribution, and protein binding affect drug clearance. RRT prescription parameters such as blood flow rate, ultrafiltration rate, membrane size, and pore size can also influence drug clearance. Furthermore, the pediatric patient presents additional concerns because of developmental factors in children that affect both pharmacokinetics of drugs.

  12. A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

    Science.gov (United States)

    Pannu, Neesh; Graham, Michelle; Klarenbach, Scott; Meyer, Steven; Kieser, Teresa; Hemmelgarn, Brenda; Ye, Feng; James, Matthew

    2016-01-01

    Background: Acute kidney injury after cardiac surgery is associated with adverse in-hospital and long-term outcomes. Novel risk factors for acute kidney injury have been identified, but it is unknown whether their incorporation into risk models substantially improves prediction of postoperative acute kidney injury requiring renal replacement therapy. Methods: We developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery. We used demographic, and preoperative clinical and laboratory data from 2 independent cohorts of adults who underwent cardiac surgery (excluding transplantation) between Jan. 1, 2004, and Mar. 31, 2009. We developed the risk prediction model using multivariable logistic regression and compared it with existing models based on the C statistic, Hosmer–Lemeshow goodness-of-fit test and Net Reclassification Improvement index. Results: We identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00–4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15–2.40), diabetes mellitus (1.61, 1.12–2.31), baseline estimated glomerular filtration rate (0.96, 0.95–0.97), increasing hemoglobin concentration (0.85, 0.77–0.93), proteinuria (1.65, 1.07–2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64–2.43), other cardiac procedure (v. CABG only, 3.11, 2.12–4.58) and emergent status for surgery booking (4.63, 2.61–8.21). The 8-variable risk prediction model had excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79–0.86). The net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score). Interpretation: We have developed

  13. Comparison of Hospitalization and Survival Between Patients Treated With Renal Replacement Therapy

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    Murat MERAL

    2011-01-01

    Full Text Available AIM: Renal replacement therapy (RRT prolongs survival in patients with end-stage-renal-disease (ESRD. We compared patient survival, number and duration of hospitalization in patients treated with RRT in this study. MATERIAL and METHODS: Two hundred and eighty seven patients (87 hemodialysis (HD, 97 peritoneal dialysis (PD, 103 renal transplant (RT patients were enrolled in this study. Patients' data were collected retrospectively from hospital records. RESULTS: HD patients were older and had more comorbid diseases compared to PD and RT patients. Mortality rates were not different between the modalitites. The number and duration of hospitalization episodes were significantly lower in the PD group than that of the other two groups. Survival rates of HD patients were 84%, 55% and 30% for the 1st, 5th and 10th years, respectively while these rates were 93%, 81% and 59% for PD and 95%, 81% and 77% for RT patients. CONCLUSION: PD and RT patients were younger than HD patients and had less comorbid diseases. As a result, the number and duration of hospitalization episodes were significantly lower in the PD group when compared to the others. Survival rates in the RT group were better than that of the HD and PD groups.

  14. Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies.

    Science.gov (United States)

    Kempke, Anna P; Leino, Abbie S; Daneshvar, Farzad; Lee, John Andrew; Mueller, Bruce A

    2016-01-01

    Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained from drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model patient using each method were compared to doses suggested in a commonly used dosing text. Results. Full pharmacokinetic data was available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively. On average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the medications. Conclusion. Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are used. Alternate, validated dosing methods need to be developed for this at-risk patient population.

  15. Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies

    Directory of Open Access Journals (Sweden)

    Anna P. Kempke

    2016-01-01

    Full Text Available Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained from drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model patient using each method were compared to doses suggested in a commonly used dosing text. Results. Full pharmacokinetic data was available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively. On average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the medications. Conclusion. Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are used. Alternate, validated dosing methods need to be developed for this at-risk patient population.

  16. Effects of continuous and intermittent renal replacement therapies among adult patients with acute kidney injury.

    Science.gov (United States)

    Schoenfelder, Tonio; Chen, Xiaoyu; Bleß, Hans-Holger

    2017-01-01

    Background: Dialysis-dependent acute kidney injury (AKI) can be treated using continuous (CRRT) or intermittent renal replacement therapies (IRRT). Although some studies suggest that CRRT may have advantages over IRRT, study findings are inconsistent. This study assessed differences between CRRT and IRRT regarding important clinical outcomes (such as mortality and renal recovery) and cost-effectiveness. Additionally, ethical aspects that are linked to renal replacement therapies in the intensive care setting are considered. Methods: Systematic searches in MEDLINE, EMBASE, and Cochrane Library including RCTs, observational studies, and cost-effectiveness studies were performed. Results were pooled using a random effects-model. Results: Forty-nine studies were included. Findings show a higher rate of renal recovery among survivors who initially received CRRT as compared with IRRT. This advantage applies to the analysis of all studies with different observation periods (Relative Risk (RR) 1.10; 95% Confidence Interval (CI) [1.05, 1.16]) and to a selection of studies with observation periods of 90 days (RR 1.07; 95% CI [1.04, 1.09]). Regarding observation periods beyond there are no differences when only two identified studies were analyzed. Patients initially receiving CRRT have higher mortality as compared to IRRT (RR 1.17; 95% CI [1.06, 1.28]). This difference is attributable to observational studies and may have been caused by allocation bias since seriously ill patients more often initially receive CRRT instead of IRRT. CRRT do not significantly differ from IRRT with respect to change of mean arterial pressure, hypotensive episodes, hemodynamic instability, and length of stay. Data on cost-effectiveness is inconsistent. Recent analyzes indicate that initial CRRT is cost-effective compared to initial IRRT due to a reduction of the rate of long-term dialysis dependence. As regards a short time horizon, this cost benefit has not been shown. Conclusion: Findings of

  17. Effects of continuous and intermittent renal replacement therapies among adult patients with acute kidney injury

    Directory of Open Access Journals (Sweden)

    Schoenfelder, Tonio

    2017-03-01

    Full Text Available Background: Dialysis-dependent acute kidney injury (AKI can be treated using continuous (CRRT or intermittent renal replacement therapies (IRRT. Although some studies suggest that CRRT may have advantages over IRRT, study findings are inconsistent. This study assessed differences between CRRT and IRRT regarding important clinical outcomes (such as mortality and renal recovery and cost-effectiveness. Additionally, ethical aspects that are linked to renal replacement therapies in the intensive care setting are considered.Methods: Systematic searches in MEDLINE, EMBASE, and Cochrane Library including RCTs, observational studies, and cost-effectiveness studies were performed. Results were pooled using a random effects-model.Results: Forty-nine studies were included. Findings show a higher rate of renal recovery among survivors who initially received CRRT as compared with IRRT. This advantage applies to the analysis of all studies with different observation periods (Relative Risk (RR 1.10; 95% Confidence Interval (CI [1.05, 1.16] and to a selection of studies with observation periods of 90 days (RR 1.07; 95% CI [1.04, 1.09]. Regarding observation periods beyond there are no differences when only two identified studies were analyzed. Patients initially receiving CRRT have higher mortality as compared to IRRT (RR 1.17; 95% CI [1.06, 1.28]. This difference is attributable to observational studies and may have been caused by allocation bias since seriously ill patients more often initially receive CRRT instead of IRRT. CRRT do not significantly differ from IRRT with respect to change of mean arterial pressure, hypotensive episodes, hemodynamic instability, and length of stay. Data on cost-effectiveness is inconsistent. Recent analyzes indicate that initial CRRT is cost-effective compared to initial IRRT due to a reduction of the rate of long-term dialysis dependence. As regards a short time horizon, this cost benefit has not been shown

  18. Dialysis patients refusing kidney transplantation: data from the Slovenian Renal Replacement Therapy Registry.

    Science.gov (United States)

    Buturović-Ponikvar, Jadranka; Gubenšek, Jakob; Arnol, Miha; Bren, Andrej; Kandus, Aljoša; Ponikvar, Rafael

    2011-06-01

    Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease; nevertheless, some dialysis patients refuse to be transplanted. The aim of our registry-based, cross-sectional study was to compare kidney transplant candidates to dialysis patients refusing transplantation. Data were collected from the Slovenian Renal Replacement Therapy Registry database, as of 31 December 2008. Demographic and some RRT data were compared between the groups. There were 1448 dialysis patients, of whom 1343 were treated by hemodialysis and 105 by peritoneal dialysis (PD); 132 (9%) were on the waiting list for transplantation, 208 (14%) were preparing for enrollment (altogether 340 [23%] dialysis patients were kidney transplant candidates); 200 (13.7%) patients were reported to refuse transplantation, all ≤ 65 years of age; 345 (24%) were not enrolled due to medical contraindications, 482 (33%) due to age, and 82 (6%) due to other or unknown reasons. No significant difference was found in age, gender, or presence of diabetes between kidney transplant candidates vs. patients refusing transplantation (mean age 50.5 ± 13.9 vs. 51.3 ± 9.6 years, males 61% vs. 63%, diabetics 18% vs. 17%). The proportion of patients ≤ 65 years old who were refusing transplantation was 28% (187/661) for hemodialysis and 17% (13/79) for PD patients (P = 0.03). There is a considerable group of dialysis patients in Slovenia refusing kidney transplantation. Compared to the kidney transplant candidates, they are similar in age, gender and prevalence of diabetes. Patients treated by peritoneal dialysis refuse kidney transplantation less often than hemodialysis patients.

  19. Nutritional status and clinical outcome of children on continuous renal replacement therapy: a prospective observational study

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    Castillo Ana

    2012-09-01

    Full Text Available Abstract Background No studies on continuous renal replacement therapy (CRRT have analyzed nutritional status in children. The objective of this study was to assess the association between mortality and nutritional status of children receiving CRRT. Methods Prospective observational study to analyze the nutritional status of children receiving CRRT and its association with mortality. The variables recorded were age, weight, sex, diagnosis, albumin, creatinine, urea, uric acid, severity of illness scores, CRRT-related complications, duration of admission to the pediatric intensive care unit, and mortality. Results The sample comprised 174 critically ill children on CRRT. The median weight of the patients was 10 kg, 35% were under percentile (P 3, and 56% had a weight/P50 ratio of less than 0.85. Only two patients were above P95. The mean age for patients under P3 was significantly lower than that of the other patients (p = 0.03. The incidence of weight under P3 was greater in younger children (p = 0.007 and in cardiac patients and in those who had previous chronic renal insufficiency (p = 0.047. The mortality analysis did not include patients with pre-existing renal disease. Mortality was 38.9%. Mortality for patients with weight P3 (51% vs 33%; p = 0.037. In the univariate and multivariate logistic regression analyses, the only factor associated with mortality was protein-energy wasting (malnutrition (OR, 2.11; 95% CI, 1.067-4.173; p = 0.032. Conclusions The frequency of protein-energy wasting in children who require CRRT is high, and the frequency of obesity is low. Protein-energy wasting is more frequent in children with previous end-stage renal disease and heart disease. Underweight children present a higher mortality rate than patients with normal body weight.

  20. Application of a pattern of incremental haemodialysis, based on residual renal function, when starting renal replacement therapy.

    Science.gov (United States)

    Merino, José L; Domínguez, Patricia; Bueno, Blanca; Amézquita, Yésika; Espejo, Beatriz; Paraíso, Vicente

    The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008. We included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: Clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities. A total of 24patients were included in incremental technique. The mean age at start of RRT was 60 (15 years. The average time on incremental technique was 19 (18 months (range: 7-80), with a mean time on dialysis of 31 (23 months (range: 12-86). The reasons for transfer to thrice-weekly HD were: in 6patients due to laboratory tests, in 2patients for heart failure events, one for poor compliance and 3for receiving a kidney graft. The residual diuresis decreased in the first year from 2,106 (606ml/day to 1,545 (558 (P=.17) with the urea clearance and calculated residual renal function, basal 5.7 (1.5vs. 3.8 (1.9ml/min per year (P=.01) and basal 8.9 (2.4vs. 6.9 (4.3 per year (P=.28), respectively. Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Renal Replacement Therapy And Increased Risk Of Cardiovascular Disease In El-Minia Governorate, Upper Egypt

    Directory of Open Access Journals (Sweden)

    El-Minshawy O*, and Kamel E G

    2006-03-01

    Full Text Available Introduction: End stage renal disease (ESRD is one of the main health problems in El Minia Governorate Currently, hemodialysis (HD represents the main mode for treatment of ESRD in El Minia Governorate. El Minia Governorate consists of 9 districts and total population of 4.6 millions. The aim of this study: is to describe the prevalence rate and etiology of ESRD in patients under Renal Replacement Therapy (RRT in El Minia Governorate during the year 2005 and risk factors for cardiovascular disease in this group of patients. Material and Method: Patients of ESRD were interviewed and questionnaires were filled out by the investigators. The questionnair included personal data, past history of relevant diseases, renal biopsy results, ultrasonography, dialysis frequency, lipid profile, ECG, Echocardiography and other data investigating the cause of ESRD and the causes of death. Results: This study included 614 patients, that is 51 % of the estimated total number of patients treated by RRT in El-Minia governorate. The prevalence of ESRD in El- Minia governorate is 260/ per million population (PMP. Most patients are treated by hemodialysis (HD (97.2 % while only 2.8% are treated by either peritoneal dialysis or renal transplantation. The etiology of ESRD was unknown in 28% of cases while hypertension was responsible for 20.7% of cases, obstructive uropathy 12.7%, chronic glomerulonephritis 10.4%, analgesic nephropathy 6% chronic pyelonephritis 5.8%, and diabetic nephropathy 5%. Other causes such as gouty nephropathy, collagen diseases, toxaemia of pregnancy and lupus nephritis constituted 7% of cases.The prevalence of ischemic heart disease was 16.5%, congestive heart failure 28% Cerebrovascular accidents 5%, the death rate among HD patients during this year was 210/1000. Recommendation: Education program for nephrologists and practitioners should be strengthened with special emphasis on etiological factors leading to ESRD , blood pressure control with

  2. Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Agarwal, Rajiv; Georgianos, Panagiotis I

    2016-05-01

    Insufficiency of 25-hydroxyvitamin D [25(OH)D] is highly prevalent among patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) and is a critical component in the pathogenesis of secondary hyperparathyroidism. Accordingly, current National Kidney Foundation-Kidney Disease Outcomes Quality Initiative and Kidney Disease: Improving Global Outcomes guidelines recommend the correction of hypovitaminosis D through nutritional vitamin D replacement as a first-step therapeutic approach targeting secondary hyperparathyroidism. In this Polar Views debate, we summarize the existing evidence, aiming to defend the position that nutritional vitamin D replacement is not evidence-based and should not be applied to patients with CKD. This position is supported by the following: (i) our meta-analysis of randomized controlled trials shows that whereas nutritional vitamin D significantly increases serum 25(OH)D levels relative to placebo, there is no evidence either in predialysis CKD or in ESRD that parathyroid hormone (PTH) is lowered; (ii) on the other hand, in randomized head-to-head comparisons, nutritional vitamin D is shown to be inferior to activated vitamin D analogs in reducing PTH levels; (iii) nutritional vitamin D is reported to exert minimal to no beneficial actions in a series of surrogate risk factors, including aortic stiffness, left ventricular mass index (LVMI), epoetin utilization and immune function among others; and (iv) there is no evidence to support a benefit of nutritional vitamin D on survival and other 'hard' clinical outcomes. Whereas nutritional vitamin D replacement may restore 25(OH)D concentration to near normal, the real target of treating vitamin D insufficiency is to treat secondary hyperparathyroidism, which is untouched by nutritional vitamin D. Furthermore, the pleotropic benefits of nutritional vitamin D remain to be proven. Thus, there is little, if any, benefit of nutritional vitamin D replacement in CKD.

  3. Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy.

    Science.gov (United States)

    Smetana, Keaton S; Cook, Aaron M; Bastin, Melissa L Thompson; Oyler, Douglas R

    2016-12-01

    The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016. Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known. Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible. Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy.

    Science.gov (United States)

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co-located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing.

  5. Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis

    DEFF Research Database (Denmark)

    Hjortrup, P B; Haase, N; Treschow, F;

    2015-01-01

    BACKGROUND: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis. METHODS: This was a prospective observational study in three general...... intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU......ROCs. CONCLUSION: In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses....

  6. Hospital costs and clinical characteristics of continuous renal replacement therapy patients: a continuous ethical dilemma.

    Science.gov (United States)

    Coustasse, Alberto

    2008-01-01

    This study describes the clinical characteristics and examines hospital costs involved in the care of 117 patients undergoing Continuous Renal Replacement Therapy (CRRT) between January 1999 and August 2002. The majority (70.9%) of the patients undergoing CRRT expired in the hospital. Statistically significant differences were found with respect to the length of stay for discharge status and gender; and with respect to costs for surgery versus no surgery and gender. Significant differences were also found between discharge status and gender, age, and cardiovascular surgery. The results of this study raise economic and ethical questions related to the cost/benefit of CRRT and the futility of the treatment. Hospitals should ensure that they have utilization protocols in place for CRRT, promote cooperation between intensive care unit (ICU) physicians and nephrologists, and create multi-disciplinary CRRT teams in an effort to maximize the effectiveness of therapy and minimize costs.

  7. Mortality from infections and malignancies in patients treated with renal replacement therapy

    DEFF Research Database (Denmark)

    Vogelzang, Judith L; van Stralen, Karlijn J; Noordzij, Marlies

    2015-01-01

    disease were associated with an increased risk of infection-related mortality. The sex difference was most pronounced for dialysis patients aged 0-39 years, with women having a 32% (adjusted HR 1.32 95% CI 1.09-1.60) higher risk of infection-related mortality than men. Mortality from malignancies was 2...... compared with the general population by age group and sex. METHODS: We followed 168 156 patients included in the ERA-EDTA registry who started RRT in 1993-2007 until 1 January 2012. Age- and cause-specific mortality rates per 1000 person-years (py) and mortality rate ratios (MRRs) compared......BACKGROUND: Infections and malignancies are the most common non-cardiovascular causes of death in patients on chronic renal replacement therapy (RRT). Here, we aimed to quantify the mortality risk attributed to infections and malignancies in dialysis patients and kidney transplant recipients when...

  8. [Disseminated intravascular coagulation and acute kidney injury requiring renal replacement therapy after diagnostic amniocentesis].

    Science.gov (United States)

    Ratković, Marina; Bašić-Jukić, Nikolina; Gledović, Branka; Radunović, Danilo

    2014-04-01

    Disseminated intravascular coagulation (DIC) is a very rare complication of amniocentesis. We present a case of a 33-year-old patient who developed DIC with acute respiratory distress syndrome and acute kidney injury after diagnostic amniocentesis. The patient required replacement of renal function for 59 days with continuous venovenous hemodiafiltration and later with hemodialysis. She was treated with heparin, fresh frozen plasma, platelets and cryoprecipitate. Her condition was further complicated with the development of intracranial hematoma. After 67 days of hospitalization, she was discharged from the hospital with serum creatinine 337 μmol/L. Three years later, her serum creatinine was 102 μmol/L, and she is currently in the 7th month of pregnancy.

  9. Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Nagarik Amit

    2010-01-01

    Full Text Available Systemic heparinization during continuous renal replacement therapy (CRRT is associated with disadvantage of risk of bleeding. This study analyses the efficacy of frequent saline flushes compared with heparin anticoagulation to maintain filter life. From January 2004 to November 2007, 65 critically ill patients with acute renal failure underwent CRRT. Continuous venovenous hemodialfiltration (CVVHDF was performed using Diapact Braun CRRT machine. 1.7% P.D. fluid was used as dialysate. 0.9% NS with addition of 10% Ca Gluconate, Magnesium Sulphate, Soda bicarbonate and Potassium Chloride added sequentially in separate units were used for replacement, carefully monitoring their levels. Anticoagulation of extracorporeal circuit was achieved with unfractionated heparin (250-500 units alternate hour in 35 patients targeting aPTT of 45-55 seconds. No anticoagulation was used in 30 patients with baseline APTT > 55 seconds and extracorporeal circuit was maintained with saline flushes at 30 min interval. 65 pa-tients including 42 males. Co-morbidities were comparable in both groups. HMARF was signifi-cantly more common in heparin group while Sepsis was comparable in both the groups. CRRT parameters were similar in both groups. Average filter life in heparin group was 26 ± 6.4 hours while it was 24.5 ± 6.36 hours in heparin free group ( P=NS. Patients receiving heparin had 16 bleeding episodes (0.45/patient while only four bleeding episodes occurred in heparin free group (0.13/patient, P< 0.05. Mortality was 71% in heparin group and 67% in heparin free group. Frequent saline flushes is an effective mode of maintainance of extracorporeal circuit in CRRT when aPTT is already on the higher side, with significantly decreased bleeding episodes.

  10. Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients.

    Science.gov (United States)

    Viallet, Nicolas; Brunot, Vincent; Kuster, Nils; Daubin, Delphine; Besnard, Noémie; Platon, Laura; Buzançais, Aurèle; Larcher, Romaric; Jonquet, Olivier; Klouche, Kada

    2016-12-01

    In acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient's outcome. In this study, we aimed to identify predictive parameters that may help to a successful RRT weaning for AKI patients. We studied 54 surviving AKI patients in which a weaning of RRT was attempted. On the day of weaning (D0) and the following 2 days (D1 and D2), SAPS II and SOFA scores, 24-h diuresis, 24-h urinary creatinine and urea (UCr and UUr), creatinine and urea generation rates (CrGR and UrGR) and clearances (CrCl and UrCl) were collected. Patients who remained free of RRT 15 days after its discontinuation were considered as successfully weaned. Twenty-six RRT weaning attempts succeeded (S+) and 28 failed (S-). Age, previous renal function, SAPS II and SOFA scores were comparable between groups. At D0, 24-h diuresis was 2300 versus 1950 ml in S+ and S-, respectively, p = 0.05. At D0, D1 and D2, 24-h UUr and UCr levels, UrCl and CrCl, and UUr/UrGR and UCr/CrGR ratios were significantly higher in S+ group. By multivariate analysis, D1 24-h UCr was the most powerful parameter that was associated with RRT weaning success with an area under the ROC curve of 0.86 [0.75-0.97] and an odds ratio of 2.01 [1.27-3.18], p = 0.003. In ICU AKI, 24-h UCr appeared as an efficient and independent marker of a successful weaning of RRT. A 24-h UCr ≥5.2 mmol was associated with a successful weaning in 84 % of patients.

  11. Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy.

    Science.gov (United States)

    Covajes, Cecilia; Scolletta, Sabino; Penaccini, Laura; Ocampos-Martinez, Eva; Abdelhadii, Ali; Beumier, Marjorie; Jacobs, Frédérique; de Backer, Daniel; Vincent, Jean-Louis; Taccone, Fabio Silvio

    2013-03-01

    Vancomycin is frequently administered as a continuous infusion to treat severe infections caused by Gram-positive bacteria. Previous studies have suggested a loading dose of 15 mg/kg followed by continuous infusion of 30 mg/kg in patients with normal renal function; however, there are no dosing recommendations in patients with renal failure undergoing continuous renal replacement therapy (CRRT). Data from all adult septic patients admitted to a Department of Intensive Care over a 3-year period in whom vancomycin was given as a continuous infusion were reviewed. Patients were included if they received vancomycin for ≥48h during CRRT. Vancomycin levels were obtained daily. During the study period, 85 patients (56 male; mean age 65±15 years; weight 85±24kg) met the inclusion criteria. Median (interquartile range) APACHE II and SOFA scores were 24 (20-29) and 11 (7-14), respectively, and the overall mortality rate was 59%. Mean vancomycin doses were 16.4±6.4 (loading dose), 23.5±8.1 (Day 1), 23.2±7.4 (Day 2) and 23.3±11.0 (Day 3) mg/kg, resulting in blood concentrations of 24.7±9.0 (Day 1), 26.0±8.1 (Day 2) and 27.7±9.3 (Day 3) μg/mL. On Day 1, 43 patients (51%) had adequate drug concentrations (20-30 μg/mL), 17 (20%) had levels >30 μg/mL and 25 (29%) had levels drug concentrations received a daily dose of 16-35 mg/kg. The intensity of CRRT directly influenced vancomycin concentrations on Day 1 of therapy. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  12. Therapeutic Drug Monitoring in Neonatal HSV Infection on Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Funaki, Takanori; Miyata, Ippei; Shoji, Kensuke; Enomoto, Yuki; Sakamoto, Seisuke; Kasahara, Mureo; Miyairi, Isao

    2015-07-01

    Optimal acyclovir dosing under continuous renal replacement therapy (CRRT) in neonates is unknown. We monitored serum acyclovir levels and herpes simplex virus 1 (HSV-1) DNA levels in a neonate with disseminated HSV-1 infection and renal failure undergoing CRRT. A full-term, 5-day-old female presented with a 2-day history of lethargy and fever. She developed fulminant hepatitis and was diagnosed with HSV-1 infection by real-time polymerase chain reaction. Acyclovir was initiated at 60 mg/kg/day, which was lowered to 20 mg/kg/day because of development of renal failure. She was placed on continuous hemodialysis. Acyclovir dosing was adjusted according to serum acyclovir levels, and HSV-1 viral load was sequentially monitored. Semiquantification of serum HSV-1 levels was performed by real-time polymerase chain reaction. Acyclovir levels were measured by using liquid chromatography-tandem mass spectrometry. Acyclovir was administered at 20 mg/kg intravenously over 1 hour; peak concentration was 18.9 μg/mL. The half-life of acyclovir was estimated to be 2 to 3 h. Viral load remained high during dosing every 24 hours, with a decline of 0.17 log copies/24 hours. Acyclovir dosing was changed to 20 mg/kg/dose every 8 hours, with an average viral load decline of 0.44 log copies/24 hours. Despite the guideline recommendation of 24-hour redosing, acyclovir was dialyzed at a rate that resulted in suboptimal treatment. Individual therapeutic drug monitoring for acyclovir and dosing adjustment may be required to optimize therapy for patients undergoing CRRT. Copyright © 2015 by the American Academy of Pediatrics.

  13. A case of sodium chlorite toxicity managed with concurrent renal replacement therapy and red cell exchange.

    Science.gov (United States)

    Romanovsky, Adam; Djogovic, Dennis; Chin, Dat

    2013-03-01

    Sodium chlorite is a powerful oxidizing agent with multiple commercial applications. We report the presentation and management of a single case of human toxicity of sodium chlorite. A 65-year-old man presented to hospital after accidentally ingesting a small amount of a sodium chlorite solution. His principal manifestations were mild methemoglobinemia, severe oxidative hemolysis, disseminated intravascular coagulation, and anuric acute kidney injury. He was managed with intermittent hemodialysis, followed by continuous venovenous hemofiltration for management of acute kidney injury and in an effort to remove free plasma chlorite. Concurrently, he underwent two red cell exchanges, as well as a plasma exchange, to reduce the burden of red cells affected by chlorite. These interventions resulted in the cessation of hemolysis with stabilization of serum hemoglobin and platelets. The patient survived and subsequently recovered normal renal function. This is only the second case of sodium chlorite intoxication reported in the medical literature and the first to report the use of renal replacement therapy in combination with red cell exchange in its management.

  14. The Challenge of Providing Renal Replacement Therapy in Developing Countries: The Latin American Perspective.

    Science.gov (United States)

    Obrador, Gregorio T; Rubilar, Ximena; Agazzi, Evandro; Estefan, Janette

    2016-03-01

    The costs of health care place developing countries under enormous economic pressure. Latin America is a region characterized by wide ethnic and per capita gross domestic product variations among different countries. Chronic kidney failure prevalence and incidence, as well as provision of renal replacement therapy (RRT), have increased in all Latin American countries over the last 20 years. From an ethical point of view, life-sustaining therapies such as RRT should be available to all patients with chronic kidney disease who might benefit. However, even among Latin American countries with similar per capita incomes and health care expenditures, only some have been able to achieve universal access to RRT. This indicates that it is not just a problem of wealth or distribution of scarce health care resources, but one of social justice. Strategies to increase the availability of RRT and renal palliative-supportive care, as well as implementation of interventions to prevent chronic kidney disease development and progression, are needed in Latin America and other developing countries.

  15. Antiepileptic Drug Removal by Continuous Renal Replacement Therapy: A Review of the Literature.

    Science.gov (United States)

    Mahmoud, Sherif Hanafy

    2017-01-01

    Continuous renal replacement therapy (CRRT) is used for managing acute kidney injury in critically ill patients. Removal of antiepileptic drugs (AEDs) by CRRT could be significant and may complicate patients' intensive care unit stay. The objective of the current review was to summarize the available evidence for AED removal by CRRT. An electronic literature search of PubMed (1946 to May 2016), Medline (1946 to May 2016), and Embase (1974 to May 2016) databases for studies discussing AED removal by CRRT was conducted. A total of 31 case reports discussing 32 patients were found. AEDs reported were levetiracetam (n = 3), valproic acid (n = 9), carbamazepine (n = 10), phenytoin (n = 3), phenobarbital (n = 4), lacosamide (n = 1), gabapentin (n = 1), and topiramate (n = 1). Two-thirds of the reports were about using CRRT in drug overdose and one-third was about AED removal by CRRT during therapy. Based on the current limited evidence and pharmacokinetic characteristics of AEDs, renally eliminated AEDs and/or AEDs with limited protein binding such as levetiracetam are more likely to be removed by CRRT than AEDs that are mainly metabolized and extensively protein bound such as carbamazepine. In conclusion, there is not enough evidence to provide robust dosing recommendations for AEDs in patients undergoing CRRT. Further studies are needed.

  16. Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Kunka, Megan E; Cady, Elizabeth A; Woo, Heejung C; Thompson Bastin, Melissa L

    2015-01-01

    Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours), which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient's actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.

  17. Experience with daptomycin daily dosing in ICU patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Preiswerk, B; Rudiger, A; Fehr, J; Corti, N

    2013-04-01

    For critically ill patients undergoing continuous renal replacement therapy (CRRT), daptomycin dosing recommendations are scarce. We, therefore, retrospectively assessed routinely measured daptomycin plasma concentrations, daptomycin dose administered and microbiological data in 11 critically ill patients with Gram-positive infections that had received daptomycin once daily. The retrospective analysis included critically ill patients treated at the intensive care unit (ICU) who had daptomycin plasma concentrations measured. Daptomycin dose ranged from 3 to 8 mg/kg/q24 h in patients undergoing CRRT (n = 7) and 6 to 10 mg/kg/q24 h in patients without CRRT (n = 4). Peak and trough concentrations showed a high intra- and inter-patient variability in both groups, independent of the dosage per kg body weight. No drug accumulation was detected in CRRT patients with once-daily daptomycin dosing. Causative pathogens were Enterococcus faecium (n = 6), coagulase-negative Staphylococcus (n = 2), Staphylococcus aureus (n = 2) and unknown in one patient. Microbiological eradication was successful in 8 of 11 patients. Two of three patients with unsuccessful microbiological eradication and fatal outcome had an Enterococcus faecium infection. In critically ill patients undergoing CRRT, daptomycin exposure with once-daily dosing was similar to ICU patients with normal renal function, but lower compared to healthy volunteers. Our data suggest that daptomycin once-daily dosing is appropriate in patients undergoing CRRT.

  18. Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Megan E. Kunka

    2015-01-01

    Full Text Available Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours, which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient’s actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.

  19. Use of Renal Replacement Therapy May Influence Graft Outcomes following Liver Transplantation for Acute Liver Failure: A Propensity-Score Matched Population-Based Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Stephen R Knight

    Full Text Available Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy.A retrospective analysis of the United Kingdom Transplant Registry was performed (1 January 2001-31 December 2011 with patient and graft survival determined using Kaplan-Meier methods. Cox proportional hazards models were used together with propensity-score based full matching on renal replacement therapy use.Three-year patient and graft survival for patients receiving renal replacement therapy were 77.7% and 72.6% compared with 85.1% and 79.4% for those not requiring renal replacement therapy (P<0.001 and P = 0.009 respectively, n = 725. In a Cox proportional hazards model, renal replacement therapy was a predictor of both patient death (hazard ratio (HR 1.59, 95% CI 1.01-2.50, P = 0.044 but not graft loss (HR 1.39, 95% CI 0.92-2.10, P = 0.114. In groups fully matched on baseline covariates, those not receiving renal replacement therapy with a serum creatinine greater than 175 μmol/L had a significantly worse risk of graft failure than those receiving renal replacement therapy.In patients being transplanted for acute liver failure, use of renal replacement therapy is a strong predictor of patient death and graft loss. Those not receiving renal replacement therapy with an elevated serum creatinine may be at greater risk of early graft failure than those receiving renal replacement therapy. A low threshold for instituting renal replacement therapy may therefore be beneficial.

  20. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

    NARCIS (Netherlands)

    A.A.N.M. Royakkers; J.C. Korevaar; J.D.E. van Suijlen; L.S. Hofstra; M.A. Kuiper; P.E. Spronk; M.J. Schultz; C.S.C. Bouman

    2011-01-01

    To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Multicenter prospective observational cohort stu

  1. The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy

    DEFF Research Database (Denmark)

    Kramer, Anneke; Stel, Vianda S; Geskus, Ronald B;

    2012-01-01

    Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account...

  2. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury

    DEFF Research Database (Denmark)

    2011-01-01

    Introduction: Our aim was to investigate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods: Systematic review and meta-analysis were used in this study. PUBMED, EMBASE, SCOPUS, Web...

  3. Pharmacokinetics of cefotaxime in critically ill patients with acute kidney injury treated with continuous renal replacement therapy : a pilot study

    NARCIS (Netherlands)

    Koedijk, Joost B; Valk-Swinkels, Corinne G H; Rijpstra, Tom A; Touw, Daan J; Mulder, Paul G H; van der Voort, Peter H J; Van't Veer, Nils E; van der Meer, Nardo J M

    2016-01-01

    INTRODUCTION: The objective of this study is to describe the pharmacokinetics of cefotaxime (CTX) in critically ill patients with acute kidney injury (AKI) when treated with continuous renal replacement therapy (CRRT) in the Intensive Care Unit (ICU). MATERIALS AND METHODS: This single-center prospe

  4. Low-flow CO2 removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements

    Science.gov (United States)

    2013-01-01

    Introduction Lung-protective ventilation in patients with ARDS and multiorgan failure, including renal failure, is often paralleled with a combined respiratory and metabolic acidosis. We assessed the effectiveness of a hollow-fiber gas exchanger integrated into a conventional renal-replacement circuit on CO2 removal, acidosis, and hemodynamics. Methods In ten ventilated critically ill patients with ARDS and AKI undergoing renal- and respiratory-replacement therapy, effects of low-flow CO2 removal on respiratory acidosis compensation were tested by using a hollow-fiber gas exchanger added to the renal-replacement circuit. This was an observational study on safety, CO2-removal capacity, effects on pH, ventilator settings, and hemodynamics. Results CO2 elimination in the low-flow circuit was safe and was well tolerated by all patients. After 4 hours of treatment, a mean reduction of 17.3 mm Hg (−28.1%) pCO2 was observed, in line with an increase in pH. In hemodynamically instable patients, low-flow CO2 elimination was paralleled by hemodynamic improvement, with an average reduction of vasopressors of 65% in five of six catecholamine-dependent patients during the first 24 hours. Conclusions Because no further catheters are needed, besides those for renal replacement, the implementation of a hollow-fiber gas exchanger in a renal circuit could be an attractive therapeutic tool with only a little additional trauma for patients with mild to moderate ARDS undergoing invasive ventilation with concomitant respiratory acidosis, as long as no severe oxygenation defects indicate ECMO therapy. PMID:23883472

  5. Inhospital and Post-discharge Changes in Renal Function After Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Blair, John E A; Brummel, Kent; Friedman, Julie L; Atri, Prashant; Sweis, Ranya N; Russell, Hyde; Ricciardi, Mark J; Malaisrie, S Chris; Davidson, Charles J; Flaherty, James D

    2016-02-15

    The aim of this study was to determine the influence of inhospital and post-discharge worsening renal function (WRF) on prognosis after transcatheter aortic valve replacement (TAVR). Severe chronic kidney disease and inhospital WRF are both associated with poor outcomes after TAVR. There are no data available on post-discharge WRF and outcomes. This was a single-center study evaluating all TAVR from June 1, 2008, to June 31, 2014. WRF was defined as an increase in serum creatinine of ≥0.3 mg/dl. Inhospital WRF was measured from day 0 until discharge or day 7 if the hospitalization was >7 days. Post-discharge WRF was measured at 30 days after discharge. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. In a series of 208 patients who underwent TAVR, 204 with complete renal function data were used in the inhospital analysis and 168 who returned for the 30-day follow-up were used in the post-discharge analysis. Inhospital WRF was seen in 28%, whereas post-discharge WRF in 12%. Inhospital and post-discharge WRF were associated with lower rates of survival; however, after multivariate analysis, only post-discharge WRF remained a predictor of 1-year mortality (hazard ratio 1.18, p = 0.030 for every 1 mg/dl increase in serum creatinine). In conclusion, the rate of inhospital WRF is higher than the rate of post-discharge WRF after TAVR, and post-discharge WRF is more predictive of mortality than inhospital WRF.

  6. Ankylosing spondylitis: a difficult diagnosis in patients on long-term renal replacement therapy.

    Science.gov (United States)

    Piccoli, Giorgina B; Quaglia, Marco; Mezza, Elisabetta; Burdese, Manuel; Lacuzzo, Candida; Bechis, Francesca; Biancone, Luigi; Anania, Patrizia; Maddalena, Emanuela; Jeantet, Alberto; Segoloni, Giuseppe P; Salvarani, Carlo

    2002-01-01

    We report the case of a 48-year-old male, whose musculoskeletal manifestations, previously related to long-term renal replacement therapy (RRT), were diagnosed as ankylosing spondylitis when symptoms changed their pattern on daily hemodialysis (DHD). The patient started RRT in 1981; in 1985 he received a cadaver graft, which failed in 1987. Secondary hyperparathyroidism, amyloid geoids, bilateral carpal tunnel syndrome and high aluminium levels were present. Musculoskeletal pain, reported since 1986, involved feet, heels, hips, shoulders, hands, spine. Symptoms impairing daily life did not improve after parathyroidectomy. He developed chronic hypotension and recurrent atrial fibrillation. In 1994 and 1998, because of thoracic pain, coronarography was performed (normal on both occasions). In June 2000, DHD was started. Equivalent renal clearance increased from 9-12 to 15-17 mL/min. Well-being remarkably improved. In September 2000, musculoskeletal pain worsened and bilateral Achilles tendinitis occurred. The worsening of musculoskeletal symptoms despite the improvements in well-being and other dialysis related symptoms prompted a re-evaluation of the case. The diagnosis of ankylosing spondylitis was based on: history of plantar fasciitis, bilateral Achilles tendinitis, inflammatory spinal pain with limitation of lumbar spine mobility (positive Schober test), radiological evidence of grade 2 bilateral sacroiliitis, presence of HLA-B27. This diagnosis cast light on the episodes of chest pain, explained by enthesopathy at the costosternal and manubriosternal joints and atrial fibrillation, due to HLA-B27 associated impairment in heart conduction. This case exemplifies the difficulty of differential diagnosis of multisystem illness in patients with long RRT follow-up.

  7. Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques.

    Science.gov (United States)

    Estupiñán-Jiménez, J C; Castro-Rincón, J M; González, O; Lora, D; López, E; Pérez-Cerdà, F

    2015-04-01

    To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality. In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007). Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Ceftolozane/Tazobactam Pharmacokinetics in a Critically Ill Adult Receiving Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Bremmer, Derek N; Nicolau, David P; Burcham, Pam; Chunduri, Anil; Shidham, Ganesh; Bauer, Karri A

    2016-05-01

    Limited data are available on ceftolozane/tazobactam dosing in patients receiving continuous renal replacement therapy (CRRT). Thus we performed a pharmacokinetic analysis of intravenous ceftolozane/tazobactam in a critically ill patient receiving CRRT at our medical center. A 47-year-old critically ill man with multidrug-resistant Pseudomonas aeruginosa pneumonia, bacteremia, and osteomyelitis was receiving ceftolozane/tazobactam 3 g (ceftolozane 2 g/tazobactam 1 g) every 8 hours while receiving continuous venovenous hemodiafiltration (CVVHDF). After the fifth dose of ceftolozane/tazobactam, plasma samples were obtained at 1-, 2-, 4-, 6-, and 8-hour time points. Two additional post-hemodialysis filter plasma samples were obtained to assess CVVHDF clearance. The maximum and minimum plasma concentrations for ceftolozane were 163.9 μg/ml and 79.4 μg/ml, respectively. The area under the plasma concentration-time curve from 0-8 hours (AUC0-8 ) was 689 μg hour/ml; the plasma half-life was 13.3 hours. The ceftolozane CVVHDF clearance and total clearance were 2.4 L/hour and 2.9 L/hour, respectively. Compared with a patient with normal renal function, this patient receiving CVVHDF had decreased ceftolozane clearance. A ceftolozane/tazobactam dosage of 1.5 g every 8 hours should adequately achieve a desired drug concentration above the minimum inhibitory concentration of 8 μg/ml for the treatment of pneumonia. Additional pharmacokinetic data are needed to confirm our results and for alternative forms of CRRT. © 2016 Pharmacotherapy Publications, Inc.

  9. Diagnosis of ureteral obstruction in patients with compromised renal function: the role of noninvasive imaging modalities.

    Science.gov (United States)

    Shokeir, Ahmed A; El-Diasty, Tarek; Eassa, Waleed; Mosbah, Ahmed; El-Ghar, Mohamed Abou; Mansour, Osama; Dawaba, Mohamed; El-Kappany, Hamdy

    2004-06-01

    We compared the role of noncontrast computerized tomography (NCCT), magnetic resonance urography (MRU), and combined abdominal radiography (KUB) and ultrasonography (US) in the diagnosis of the cause of ureteral obstruction in patients with compromised renal function. The study included 149 patients, of whom 110 had bilateral obstruction and 39 had obstruction of a solitary kidney. Therefore, the total number of renal units was 259. All patients had renal impairment with serum creatinine greater than 2.5 mg/dl. Besides conventional KUB and US all patients underwent NCCT and MRU. The gold standard for diagnosis of the cause of obstruction included retrograde or antegrade ureterogram, ureteroscopy and/or open surgery. The sensitivity, specificity and overall accuracy of NCCT, MRU, and combined KUB and US in the diagnosis of ureteral obstruction were calculated in comparison with the gold standard. The definitive cause of ureteral obstruction was calculous in 146 and noncalculous in 113 renal units, including ureteral stricture in 65, bladder or ureter in 43, extraurinary collection in 3 and retroperitoneal fibrosis in 2. The site of stone impaction was identified by NCCT in all 146 renal units (100% sensitivity), by MRU in 101 (69.2% sensitivity), and by combined KUB and US in 115 (78.7% sensitivity) with a difference of significant value in favor of NCCT (p MRU in 54 of 65 (83%). Bladder and ureteral tumors causing ureteral obstruction could be diagnosed in approximately half of the patients by NCCT (22 of 43) and in all except 1 by MRU (42 of 43). NCCT and MRU could identify all extraurinary causes of obstruction. Overall of the 113 kidneys with noncalculous obstruction the cause could be identified by MRU in 101 (89% sensitivity), by NCCT in 45 (40% sensitivity), and by combined KUB and US in only 20 (18% sensitivity) with a difference of significant value in favor of MRU (p MRU is superior for identifying noncalculous lesions.

  10. A primer on continuous renal replacement therapy for critically ill patients.

    Science.gov (United States)

    Joy, M S; Matzke, G R; Armstrong, D K; Marx, M A; Zarowitz, B J

    1998-03-01

    To characterize the multiple continuous renal replacement therapy (CRRT) techniques available for the management of critically ill adults, and to review the indications for and complications of use, principles of drug removal during CRRT, drug dosage individualization guidelines, and the influence of CRRT on patient outcomes. MEDLINE (January 1981-December 1996) was searched for appropriate publications by using terms such as hemofiltration, ultrafiltration, hemodialysis, hemodiafiltration, medications, and pharmacokinetics; selected articles were cross-referenced. References selected were those considered to enhance the reader's knowledge of the principles of CRRT, and to provide adequate therapies on drug disposition. CRRTs use filtration/convection and in some cases diffusion to treat hemodynamically unstable patients with fluid overload and/or acute renal failure. Recent data suggest that positive outcomes may also be attained in patients with other medical conditions such as septic shock, multiple organ dysfunction syndrome, and hepatic failure. Age, ventilator support, inotropic support, reduced urine volume, and elevated serum bilirubin concentrations have been associated with poor outcomes. Complications associated with CRRT include bleeding due to excessive anticoagulation and line disconnections, fluid and electrolyte imbalance, and filter and venous clotting. CRRT can complicate the medication regimens of patients for whom it is important to maintain drug plasma concentrations within a narrow therapeutic range. Since the physicochemical characteristics of a drug and procedure-specific factors can alter drug removal, a thorough assessment of all factors needs to be considered before dosage regimens are revised. In addition, an algorithm for drug dosing considerations based on drug and CRRT characteristics, as well as standard pharmacokinetic equations, is proposed. The use of CRRT has expanded to encompass the treatment of disease states other than just

  11. Annual Report of the German Renal Registry 1998. QuaSi-Niere Task Group for Quality Assurance in Renal Replacement Therapy.

    Science.gov (United States)

    Frei, U; Schober-Halstenberg, H J

    1999-05-01

    During the past 3 years, the basis of a German Renal Registry has been established. An agreement between end-stage renal disease (ESRD) therapy providers, insurance companies and the government has been reached to fund and support the registry office and its electronic data base. An overall acceptable compliance has been achieved to provide data voluntarily, although in the future the data submission will have to be mandatory to achieve complete data sampling within an acceptable time frame. In Germany, 713 patients per million population (p.m.p.) are on renal replacement therapy (RRT). The incidence of new patients commencing RRT is 156 p.m.p. These numbers are comparable with those reported from other European countries such as France, Italy and Spain, but significantly lower than those reported from the US or Japan. More than 92% of all dialysis patients are treated by haemodialysis and only a limited number with peritoneal dialysis. Approximately 25% of the patients have a functioning kidney graft. The transplantation rate of 25 p.m.p. is far from sufficient if compared with Spain, Austria or the US. Although an increasing number of diabetic patients commenced RRT, the percentage, i.e. approximately 30%, is less than in the US or Japan. The annual growth of the population on renal replacement cannot currently be given precisely because the database is still limited, but it seems to be approximately 3-4%.

  12. Reliability of whole slide images as a diagnostic modality for renal allograft biopsies.

    Science.gov (United States)

    Jen, Kuang-Yu; Olson, Jean L; Brodsky, Sergey; Zhou, Xin J; Nadasdy, Tibor; Laszik, Zoltan G

    2013-05-01

    The use of digital whole slide images (WSI) in the field of pathology has become feasible for routine diagnostic purposes and has become more prevalent in recent years. This type of technology offers many advantages but must show the same degree of diagnostic reliability as conventional glass slides. Several studies have examined this issue in various settings and indicate that WSI are a reliable method for diagnostic pathology. Since transplant pathology is a highly specialized field that requires not only accurate but rapid diagnostic evaluation of biopsy materials, this field may greatly benefit from the use of WSI. In this study, we assessed the reliability of using WSI compared to conventional glass slides in renal allograft biopsies. We examined morphologic features and diagnostic categories defined by the Banff 07 Classification of Renal Allograft Pathology as well as additional morphologic features not included in this classification scheme. We found that intraobserver scores, when comparing the use of glass slides versus WSI, showed substantial agreement for both morphologic features (κ = 0.68) and acute rejection diagnostic categories (κ = 0.74). Furthermore, interobserver reliability was comparable for morphologic features (κ = 0.44 [glass] vs 0.42 [WSI]) and acute rejection diagnostic categories (κ = 0.49 [glass] vs 0.51 [WSI]). These data indicate that WSI are as reliable as glass slides for the evaluation of renal allograft biopsies.

  13. Successful Renal Replacement Therapy for a Patient with Severe Hemophilia after Surgical Treatment of Intracranial Hemorrhage and Hydrocephalus

    Directory of Open Access Journals (Sweden)

    Noriko Kato

    2011-01-01

    Full Text Available A 21-year-old Japanese male with severe hemophilia A was developed end-stage renal failure. He was placed on combination therapy with peritoneal dialysis (PD and hemodialysis (HD. Eight months later, he developed a hypertensive cerebral hemorrhage. After emergency surgery, he was managed with PD without HD to avoid cerebral edema. One month later, his renal replacement therapy was switched to HD (three times a week from PD, since a ventriculoperitoneal shunt catheter was placed to treat his hydrocephalus. HD could be performed safety without anticoagulant agents on condition that factor VIII is given after every HD.

  14. Preliminary Diffusive Clearance of Silicon Nanopore Membranes in a Parallel Plate Configuration for Renal Replacement Therapy

    Science.gov (United States)

    Kim, Steven; Heller, James; Iqbal, Zohora; Kant, Rishi; Kim, Eun Jung; Durack, Jeremy; Saeed, Maythem; Do, Loi; Hetts, Steven; Wilson, Mark; Brakeman, Paul; Fissell, William H.; Roy, Shuvo

    2015-01-01

    Silicon nanopore membranes (SNM) with compact geometry and uniform pore size distribution have demonstrated a remarkable capacity for hemofiltration. These advantages could potentially be used for hemodialysis. Here we present an initial evaluation of the SNM’s mechanical robustness, diffusive clearance, and hemocompatibility in a parallel plate configuration. Mechanical robustness of the SNM was demonstrated by exposing membranes to high flows (200ml/min) and pressures (1,448mmHg). Diffusive clearance was performed in an albumin solution and whole blood with blood and dialysate flow rates of 25ml/min. Hemocompatibility was evaluated using scanning electron microscopy and immunohistochemistry after 4-hours in an extra-corporeal porcine model. The pressure drop across the flow cell was 4.6mmHg at 200ml/min. Mechanical testing showed that SNM could withstand up to 775.7mmHg without fracture. Urea clearance did not show an appreciable decline in blood versus albumin solution. Extra-corporeal studies showed blood was successfully driven via the arterial-venous pressure differential without thrombus formation. Bare silicon showed increased cell adhesion with a 4.1 fold increase and 1.8 fold increase over polyethylene-glycol (PEG)-coated surfaces for tissue plasminogen factor (t-PA) and platelet adhesion (CD-41), respectively. These initial results warrant further design and development of a fully scaled SNM-based parallel plate dialyzer for renal replacement therapy. PMID:26692401

  15. Effect of regional citrate anticoagulation on critical patients with continuous renal replacement therapy

    Institute of Scientific and Technical Information of China (English)

    Li-Li You

    2016-01-01

    Objective:To investigate the efficacy and safety of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) for critical patients.Methods:A total of 83 critical patients need CRRT in the intensive care units of our hospital from July 2012 to June 2016 were recruited in the study, and the patients were divided into two groups randomly, the patients in observation group received the RCA treatment, and the patients in control group received traditional low molecular heparin anticoagulation. The difference of safety indicators, biochemical indicators, extracorporeal circulation blood coagulation condition and complications in patients were determined between two groups.Results: Compared with control group, the patients in observation group had an elevated level of iCa2+, the level of chloride ion reduced, the use time of filter increased, the bleeding cases reduced, the concentrations of urea nitrogen, creatinine TNF-α, IL-1β, IL-8 and NO were all significantly downregulated, the data have a significant difference (P < 0.05).Conclusions:RCA is a safe and effective method for CRRT in patients with a high risk of bleeding.

  16. Quality control system to support comparability assessment for the Renal Bio-Replacement therapy system.

    Science.gov (United States)

    Pitkin, Z

    2005-01-01

    Cell therapies offer great promise for treating serious and life-threatening diseases, as cells provide the dynamic, interactive therapy that responds to the patient's condition. The spectrum of cell therapies is very broad, but each requires characterization during product development. During the development of a cell therapy, changes are made to improve product quality, purity, yield, and consistency, as well as to meet other production requirements. Multiple factors have to be considered when changes are made. A well thought-out design of comparability protocols has to reflect the international consensus set forth by the International Conference on Harmonization (ICH) and Food and Drug Administration (FDA). Comparability studies, due to their importance for the entire product development, constitute an additional challenge for the Quality System, which supports manufacturing. A comparability study was conducted to support the transfer of a cell-based technology, the Renal Bio-Replacement (RBR) system, from an academic laboratory to a contract manufacturing facility. The quality control programme supporting the RBR, and issues encountered in the comparability of the RBR therapy system, are discussed in this article.

  17. Preliminary Diffusive Clearance of Silicon Nanopore Membranes in a Parallel Plate Configuration for Renal Replacement Therapy.

    Science.gov (United States)

    Kim, Steven; Heller, James; Iqbal, Zohora; Kant, Rishi; Kim, Eun Jung; Durack, Jeremy; Saeed, Maythem; Do, Loi; Hetts, Steven; Wilson, Mark; Brakeman, Paul; Fissell, William H; Roy, Shuvo

    2016-01-01

    Silicon nanopore membranes (SNMs) with compact geometry and uniform pore size distribution have demonstrated a remarkable capacity for hemofiltration. These advantages could potentially be used for hemodialysis. Here, we present an initial evaluation of the SNM's mechanical robustness, diffusive clearance, and hemocompatibility in a parallel plate configuration. Mechanical robustness of the SNM was demonstrated by exposing membranes to high flows (200 ml/min) and pressures (1,448 mm Hg). Diffusive clearance was performed in an albumin solution and whole blood with blood and dialysate flow rates of 25 ml/min. Hemocompatibility was evaluated using scanning electron microscopy and immunohistochemistry after 4 hours in an extracorporeal porcine model. The pressure drop across the flow cell was 4.6 mm Hg at 200 ml/min. Mechanical testing showed that SNM could withstand up to 775.7 mm Hg without fracture. Urea clearance did not show an appreciable decline in blood versus albumin solution. Extracorporeal studies showed blood was successfully driven via the arterial-venous pressure differential without thrombus formation. Bare silicon showed increased cell adhesion with a 4.1-fold increase and 1.8-fold increase over polyethylene glycol (PEG)-coated surfaces for tissue plasminogen factor (t-PA) and platelet adhesion (CD41), respectively. These initial results warrant further design and development of a fully scaled SNM-based parallel plate dialyzer for renal replacement therapy.

  18. Continuous renal replacement therapy. Keeping pace with changes in technology and technique.

    Science.gov (United States)

    Baldwin, Ian

    2002-01-01

    The rapidly changing nature of new technologies and techniques in acute health care means it can be difficult keeping pace. Most facilities, large or small, are usually in continuous evaluation of a new technology. Published reviews and professional group guidelines can assist the process of change for continuous renal replacement therapy (CRRT) technologies and techniques. The current techniques and technologies are a mixed application of old and new technologies providing a combination of convective and diffusive solute clearance methods. There are a variety of anticoagulation approaches. New, purpose-built CRRT machines offer many advantages over old technology but their costs can be prohibitive and users do not always meet them with rapid behavioral change. Reading journal publications and texts, scientific meetings, education and training, Internet web site review/participation, quality improvement activities and an accurate local data base are the keys to keeping pace with changes and identifying whether a benefit can be anticipated and demonstrated. Possible changes for the future of techniques and technologies may be in the areas of modified approaches to continuous therapy with tailored approaches for specific patient care settings. Improved membrane characteristics for wider indications and the bio-artificial kidney are emerging along with blood pump and circuit design improvements, with new machine/operator interfaces.

  19. Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice.

    Science.gov (United States)

    Oudemans-van Straaten, Heleen M; Ostermann, Marlies

    2012-12-07

    To prevent clotting in the extracorporeal circuit during continuous renal replacement therapy (CRRT) anticoagulation is required. Heparin is still the most commonly used anticoagulant. However, heparins increase the risk of bleeding, especially in critically ill patients. Evidence has accumulated that regional anticoagulation of the CRRT circuit with citrate is feasible and safe. Compared to heparin, citrate anticoagulation reduces the risk of bleeding and requirement for blood products, not only in patients with coagulopathy, but also in those without. Metabolic complications are largely prevented by the use of a strict protocol, comprehensive training and integrated citrate software. Recent studies indicate that citrate can even be used in patients with significant liver disease provided that monitoring is intensified and the dose is carefully adjusted. Since the citric acid cycle is oxygen dependent, patients at greatest risk of accumulation seem to be those with persistent lactic acidosis due to poor tissue perfusion. The use of citrate may also be associated with less inflammation due to hypocalcemia-induced suppression of intracellular signaling at the membrane and avoidance of heparin, which may have proinflammatory properties. Whether these beneficial effects increase patient survival needs to be confirmed. However, other benefits are the reason that citrate should become the first choice anticoagulant for CRRT provided that its safe use can be guaranteed.

  20. Citrate versus unfractionated heparin for anticoagulation in continuous renal replacement therapy

    Institute of Scientific and Technical Information of China (English)

    LIAO Yu-jie; ZHANG Ling; ZENG Xiao-xi; FU Ping

    2013-01-01

    Background Unfractionated heparin is the most commonly used anticoagulant in continuous renal replacement therapy (CRRT),but it can increase the risk of bleeding.Citrate is a promising substitute.Our study was to assess the efficacy and safety of citrate versus unfractionated heparin in CRRT.Methods We searched the MEDLINE,the EMBASE,the Cochrane Central Register of Controlled Trials,and the China National Knowledge Infrastructure Database until up to November 2011 for randomized controlled trials comparing citrate with unfractionated heparin in adult patients with acute kidney injury prescribed CRRT.The primary outcome was mortality and the secondary outcomes included circuit survival,control of uremia,risk of bleeding,transfusion rates,acid-base statuses,and disturbance of sodium and calcium homeostasis.Results Four trials met the inclusion criteria.Meta-analysis found no significant difference between two anticoagulants on mortality.Less bleeding and more hypocalcemic episodes were with citrate.Citrate was superior or comparable to unfractionated heparin in circuit life.Conclusions Citrate anticoagulation in CRRT seems to be superior in reducing bleeding risk and with a longer or similar circuit life,although there is more metabolic derangement.Mortality superiority has not been approved.

  1. Meropenem in children receiving continuous renal replacement therapy: clinical trial simulations using realistic covariates.

    Science.gov (United States)

    Nehus, Edward J; Mouksassi, Samer; Vinks, Alexander A; Goldstein, Stuart

    2014-12-01

    Meropenem is frequently prescribed in children receiving continuous renal replacement therapy (CRRT). Fluid overload is often present in critically ill children and affects drug disposition. The purpose of this study was to develop a pharmacokinetic model to (1) evaluate target attainment of meropenem dosing regimens against P. aeruginosa in children receiving CRRT and (2) estimate the effect of fluid overload on target attainment. Clinical trial simulations were employed to evaluate target attainment of meropenem in various age groups and degrees of fluid overload in children receiving CRRT. Pharmacokinetic parameters were extracted from published literature, and 287 patients from the prospective pediatric CRRT registry database provided realistic clinical covariates including patient weight, fluid overload, and CRRT prescription characteristics. Target attainment at 40% and 75% time above the minimum inhibitory concentration was evaluated. Clinical trial simulations demonstrated that children greater than 5 years of age achieved acceptable target attainment with a dosing regimen of 20 mg/kg every 12 hours. In children less than 5, however, increased dosing of 20 mg/kg every 8 hours was needed to optimize target attainment. Fluid overload did not affect target attainment. These in silico model predictions will need to be verified in vivo in children receiving meropenem and CRRT. © 2014, The American College of Clinical Pharmacology.

  2. Pharmacokinetics of Procainamide and N-acetylprocainamide during Continuous Renal Replacement Therapy

    Science.gov (United States)

    Mohamed, Ahmed N.; Abdelhady, Ahmed M.; Spencer, Dustin; Sowinski, Kevin M.; Tisdale, James E.; Overholser, Brian R.

    2013-01-01

    Procainamide and its major metabolite, N-acetyl procainamide (NAPA), prolong the QTc interval and can promote potentially fatal ventricular arrhythmias. Excretion of procainamide and NAPA is reduced in patients with chronic kidney disease (CKD) resulting in drug accumulation and toxicity. The elimination of procainamide or NAPA in patients undergoing continuous renal replacement therapy (CRRT) has not been evaluated increasing the risk for subtherapeutic or toxic dosing regimens. This case report describes a patient undergoing CRRT who was administered procainamide for recurring ventricular tachycardia (VT) over approximately a 36 hour period. The patient required increased vasopressor therapy and developed QTc prolongation during procainamide administration. The VT resided following pacemaker adjustments, procainamide administration, and multiple direct current cardioversion attempts. Procainamide and NAPA concentrations were determined over a 120 hour period as part of routine clinical care and a pharmacokinetic (PK) model was developed using NONMEM. The developed PK model was used to simulate several procainamide dosing regimens to optimize therapy during CRRT. Based on the model-based simulations, a 50% reduction in the procainamide maintenance dose (2 mg/min) in CKD patients on CRRT can achieve therapeutic plasma procainamide and combined procainamide/NAPA concentrations. PMID:23562328

  3. Data analytics for continuous renal replacement therapy: historical limitations and recent technology advances.

    Science.gov (United States)

    Clark, William R; Garzotto, Francesco; Neri, Mauro; Lorenzin, Anna; Zaccaria, Marta; Ronco, Claudio

    2016-10-10

    Dialysis is a highly quantitative therapy involving large volumes of both clinical and technical data. While automated data collection has been implemented for chronic dialysis, this has not been done for acute kidney injury patients treated with continuous renal replacement therapy (CRRT). After a brief review of the fundamental aspects of electronic medical records (EMRs), a new tool designed to provide clinicians with individualized CRRT treatment data is analyzed, with emphasis on its quality assurance capabilities. The first platform addressing the problem of data collection and management with current CRRT machines (Sharesource system; Baxter Healthcare) is described. The system provides connectivity for the Prismaflex CRRT machine and enables both EMR connectivity and therapy analytics with 2 basic components: the connect module and the report module. The enormous amount of data in CRRT should be collected and analyzed to enable adequate clinical decisions. Current CRRT technology presents significant limitations with consequent lack of rigorous analysis of technical data and relevant feedback. From a quality assurance perspective, these limitations preclude any systematic assessment of prescription and delivery trends that may be adversely affecting clinical outcomes. A detailed assessment of current practice limitations is provided together with several possible ways to address such limitations by a new technical tool.

  4. Illness Beliefs in End Stage Renal Disease and Associations with Self-Care Modality Choice.

    Science.gov (United States)

    Jayanti, Anuradha; Foden, Philip; Wearden, Alison; Mitra, Sandip

    2016-01-01

    Interest in self-care haemodialysis (HD) has increased because it improves patients'clinical and quality-of-life outcomes. Patients who undertake self-management for haemodialysis may hold illness beliefs differently to those choosing institutional care at the time of making the modality choice or moulded by their illness and dialysis treatment experience. Illness perceptions amongst predialysis patients and in those undertaking fully-assisted and self-care haemodialysis are being investigated in a combined cross-sectional and longitudinal study. The study data are derived from the BASIC-HHD study, a multicentre observational study on factors influencing home haemodialysis uptake. 535 patients were enrolled into three groups: Predialysis CKD-5 group, prevalent 'in-centre' HD and self-care HD groups (93% at home). We explore illness perceptions in the cross-sectional analyses of the three study groups, using the revised Illness Perception Questionnaire (IPQ-R). Predialysis patients' illness beliefs were reassessed prospectively, typically between 4 and 12 months after dialysis commencement. Illness belief subscales are significantly different between in-centre and self-care HD groups. In a step-wise hierarchical regression analysis, after adjustment for age, education, marital status, diabetes, dialysis vintage, depression, anxiety scores, and IPQ-R subscales, personal control (p = 0.01) and illness coherence (p = 0.04) are significantly higher in the self-care HD group. In the predialysis group, no significant associations were found between illness representations and modality choices. In prospectively observed predialysis group, scores for personal control, treatment control, timeline cyclical and emotional representations reduced significantly after commencing dialysis and increased significantly for illness coherence. Illness beliefs differ between hospital and self-care haemodialysis patients. Patient's affect and neurocognitive ability may have an important

  5. Illness Beliefs in End Stage Renal Disease and Associations with Self-Care Modality Choice.

    Directory of Open Access Journals (Sweden)

    Anuradha Jayanti

    Full Text Available Interest in self-care haemodialysis (HD has increased because it improves patients'clinical and quality-of-life outcomes. Patients who undertake self-management for haemodialysis may hold illness beliefs differently to those choosing institutional care at the time of making the modality choice or moulded by their illness and dialysis treatment experience. Illness perceptions amongst predialysis patients and in those undertaking fully-assisted and self-care haemodialysis are being investigated in a combined cross-sectional and longitudinal study.The study data are derived from the BASIC-HHD study, a multicentre observational study on factors influencing home haemodialysis uptake. 535 patients were enrolled into three groups: Predialysis CKD-5 group, prevalent 'in-centre' HD and self-care HD groups (93% at home. We explore illness perceptions in the cross-sectional analyses of the three study groups, using the revised Illness Perception Questionnaire (IPQ-R. Predialysis patients' illness beliefs were reassessed prospectively, typically between 4 and 12 months after dialysis commencement.Illness belief subscales are significantly different between in-centre and self-care HD groups. In a step-wise hierarchical regression analysis, after adjustment for age, education, marital status, diabetes, dialysis vintage, depression, anxiety scores, and IPQ-R subscales, personal control (p = 0.01 and illness coherence (p = 0.04 are significantly higher in the self-care HD group. In the predialysis group, no significant associations were found between illness representations and modality choices. In prospectively observed predialysis group, scores for personal control, treatment control, timeline cyclical and emotional representations reduced significantly after commencing dialysis and increased significantly for illness coherence.Illness beliefs differ between hospital and self-care haemodialysis patients. Patient's affect and neurocognitive ability may have an

  6. Illness Beliefs in End Stage Renal Disease and Associations with Self-Care Modality Choice

    Science.gov (United States)

    Jayanti, Anuradha; Foden, Philip; Wearden, Alison; Mitra, Sandip

    2016-01-01

    Background Interest in self-care haemodialysis (HD) has increased because it improves patients’clinical and quality-of-life outcomes. Patients who undertake self-management for haemodialysis may hold illness beliefs differently to those choosing institutional care at the time of making the modality choice or moulded by their illness and dialysis treatment experience. Illness perceptions amongst predialysis patients and in those undertaking fully-assisted and self-care haemodialysis are being investigated in a combined cross-sectional and longitudinal study. Study Design The study data are derived from the BASIC-HHD study, a multicentre observational study on factors influencing home haemodialysis uptake. 535 patients were enrolled into three groups: Predialysis CKD-5 group, prevalent ‘in-centre’ HD and self-care HD groups (93% at home). We explore illness perceptions in the cross-sectional analyses of the three study groups, using the revised Illness Perception Questionnaire (IPQ-R). Predialysis patients’ illness beliefs were reassessed prospectively, typically between 4 and 12 months after dialysis commencement. Results Illness belief subscales are significantly different between in-centre and self-care HD groups. In a step-wise hierarchical regression analysis, after adjustment for age, education, marital status, diabetes, dialysis vintage, depression, anxiety scores, and IPQ-R subscales, personal control (p = 0.01) and illness coherence (p = 0.04) are significantly higher in the self-care HD group. In the predialysis group, no significant associations were found between illness representations and modality choices. In prospectively observed predialysis group, scores for personal control, treatment control, timeline cyclical and emotional representations reduced significantly after commencing dialysis and increased significantly for illness coherence. Conclusions Illness beliefs differ between hospital and self-care haemodialysis patients. Patient

  7. Replacement

    Directory of Open Access Journals (Sweden)

    S. Radhakrishnan

    2014-03-01

    Full Text Available The fishmeal replaced with Spirulina platensis, Chlorella vulgaris and Azolla pinnata and the formulated diet fed to Macrobrachium rosenbergii postlarvae to assess the enhancement ability of non-enzymatic antioxidants (vitamin C and E, enzymatic antioxidants (superoxide dismutase (SOD and catalase (CAT and lipid peroxidation (LPx were analysed. In the present study, the S. platensis, C. vulgaris and A. pinnata inclusion diet fed groups had significant (P < 0.05 improvement in the levels of vitamins C and E in the hepatopancreas and muscle tissue. Among all the diets, the replacement materials in 50% incorporated feed fed groups showed better performance when compared with the control group in non-enzymatic antioxidant activity. The 50% fishmeal replacement (best performance diet fed groups taken for enzymatic antioxidant study, in SOD, CAT and LPx showed no significant increases when compared with the control group. Hence, the present results revealed that the formulated feed enhanced the vitamins C and E, the result of decreased level of enzymatic antioxidants (SOD, CAT and LPx revealed that these feeds are non-toxic and do not produce any stress to postlarvae. These ingredients can be used as an alternative protein source for sustainable Macrobrachium culture.

  8. [Effect of continuous renal replacement therapy on the plasma concentration of imipenem in severe infection patients with acute renal injury].

    Science.gov (United States)

    Yu, Bin; Liu, Lixia; Xing, Dong; Zhao, Congcong; Hu, Zhenjie

    2015-05-01

    To investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment. A prospective observational study was conducted. All adult severe infection patients complicating acute kidney injury (AKI) in the Department of Critical Care Medicine of the Fourth Hospital of Hebei Medical University from March 2013 to September 2014, who were prescribed imipenem as part of their required medical care, and CRRT for treatment of AKI were enrolled. 0.5 g doses of imipenem was administered intravenously every 6 hours or 8 hours according to random number table, and infused over 0.5 hour. The unfractionated heparin was used for anticoagulation in the patients without contraindications, and no anticoagulation strategy was used in the patients with high risk of bleeding. At 24 hours after first time of administration, postfilter venous blood and ultrafiltrate samples were collected at 0, 0.25, 0.5, 0.75, 1, 2, 5, 6, and 8 hours after imipenem administration. The concentration of imipenem in above samples was determined with liquid chromatography-mass spectrometer/mass spectrometer (LC-MS/MS). A total of 25 patients were enrolled. Thirteen patients received imipenem intravenously every 6 hours, and 12 patients, every 8 hours. The anticoagulation was conducted with heparin in 13 cases, and 12 cases without anticoagulation. The intra-day precision, inter-day precision, matrix effect, and recovery rate in low, medium, and high concentration of plasma and ultrafiltrate, and the stability of samples under different conditions showed a good result, the error of accuracy was controlled in the range of ±15%. With the application of Prismaflex

  9. Maps of systematic variation in renal replacement therapy in Catalonia (2002-2012).

    Science.gov (United States)

    Tebé Condomí, Cristian; Arcos, Emma; Comas, Jordi; Espallargues, Mireia; Pons, Joan M V; Díaz, Joan M; Tort, Jaume; Martinez-Castelao, Alberto

    Variations in the use of healthcare services can be defined as systematic variations of adjusted rates for certain aggregation levels of the population. The study analyses how renal replacement therapy (RRT) is used, identifying RRT variability in Catalonia from 2002 to 2012. Ecological study by health area using data from the Catalan renal registry. We present incident rates, standardised incidence ratios and prevalence, while variability was calculated through direct and indirect standardisation methods. From 2002 until 31/12/2012, 10,784 patients initiated RRT in Catalonia: 9,238 on haemodialysis (HD) (50 treatments per 100,000 people 2010/2012), 1,076 on peritoneal dialysis (PD) (8.2 treatments per 100,000 people 2010/2012) and 470 received an early kidney transplant (KT) (4.4 treatments per 100,000 people 2010/2012). Over the 10 years, the HD cumulative incidence rate fell (7%), while the PD and KT incidence rates increased (63% and 177%, respectively); both are higher in young patients (<45 years). 4,750 patients received a kidney transplant in this period, 49% of which were aged between 45 and 65 years. There were no significant differences in variability in HD (RV5-95=1.3; Empirical Bayes [EB]∼ 0), or in the prevalence of KT (RV5-95=1.4; EB ∼ 0). Nevertheless, we found significant geographical variability in PD; notably in the districts of the province of Lérida, where the number of cases observed was greater than expected (RV5-95=4.01; EB=0.08). Although there was a notable rise in PD and early KT incidence rates, PD is still underused when compared to international recommendations. No territorial variability was found for HD or KT, but the use of PD was found to be higher in Lérida than in other areas. To reduce PD territorial variability and increase the uptake of this technique in the other regions, we propose 3initiatives: The development of RRT support tools for shared decision-making, the encouragement of specific PD professional training and

  10. Development of a decision aid to inform patients’ and families’ renal replacement therapy selection decisions

    Directory of Open Access Journals (Sweden)

    Ameling Jessica M

    2012-12-01

    Full Text Available Abstract Background Few educational resources have been developed to inform patients’ renal replacement therapy (RRT selection decisions. Patients progressing toward end stage renal disease (ESRD must decide among multiple treatment options with varying characteristics. Complex information about treatments must be adequately conveyed to patients with different educational backgrounds and informational needs. Decisions about treatment options also require family input, as families often participate in patients’ treatment and support patients’ decisions. We describe the development, design, and preliminary evaluation of an informational, evidence-based, and patient-and family-centered decision aid for patients with ESRD and varying levels of health literacy, health numeracy, and cognitive function. Methods We designed a decision aid comprising a complementary video and informational handbook. We based our development process on data previously obtained from qualitative focus groups and systematic literature reviews. We simultaneously developed the video and handbook in “stages.” For the video, stages included (1 directed interviews with culturally appropriate patients and families and preliminary script development, (2 video production, and (3 screening the video with patients and their families. For the handbook, stages comprised (1 preliminary content design, (2 a mixed-methods pilot study among diverse patients to assess comprehension of handbook material, and (3 screening the handbook with patients and their families. Results The video and handbook both addressed potential benefits and trade-offs of treatment selections. The 50-minute video consisted of demographically diverse patients and their families describing their positive and negative experiences with selecting a treatment option. The video also incorporated health professionals’ testimonials regarding various considerations that might influence patients’ and families

  11. To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: the eternal doubt.

    Science.gov (United States)

    Wong, Wai-Tat; Choi, Gordon; Gomersall, Charles D; Lipman, Jeffrey

    2015-10-01

    Critical illness, acute renal failure and continuous renal replacement therapy (CRRT) are associated with changes in pharmacokinetics. Initial antibiotic dose should be based on published volume of distribution and generally be at least the standard dose, as volume of distribution is usually unchanged or increased. Subsequent doses should be based on total clearance. Total clearance varies with the CRRT clearance which mainly depends on effluent flow rate, sieving coefficient/saturation coefficient. As antibiotic clearance by healthy kidneys is usually higher than clearance by CRRT, except for colistin, subsequent doses should generally be lower than given to patients without renal dysfunction. In the future therapeutic drug monitoring, together with sophisticated pharmacokinetic models taking into account the pharmacokinetic variability, may enable more appropriate individualized dosing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continous renal replacement therapy with calcium-free replacement solution

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    See Kay

    2009-01-01

    Full Text Available Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group, received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020. When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069, but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001.

  13. Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement: A Propensity Score Matching Analysis

    Science.gov (United States)

    Lin, Chun-Yu; Tsai, Feng-Chun; Chen, Yung-Chang; Lee, Hsiu-An; Chen, Shao-Wei; Liu, Kuo-Sheng; Lin, Pyng-Jing

    2016-01-01

    Abstract Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency. From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30–89 mL/min/1.73 m2) or normal (eGFR, ≥90 mL/min/1.73 m2). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group. Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P 72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343–4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05). Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or

  14. Therapeutic effects of continuous renal replacement in patients with multiple organ dysfunction syndrome in ICU

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    Shuang-qing LIU

    2013-05-01

    Full Text Available Objective  To investigate the effects of continuous renal replacement therapy (CRRT on patients with multiple organ dysfunction syndrome (MODS. Methods  Forty-seven patients with MODS, admitted to the Department of SICU of First Affiliated Hospital of General Hospital of PLA, were divided into two groups according to the causative agents: the sepsis group (n=28 and the non-sepsis group (n=19. All the patients involved were treated with CRRT therapy. The systemic and brain hemodynamic parameters, and oxygenation and metabolic variables were assessed immediately before and 12 hours after CRRT. The expected mortality was obtained by APACHE Ⅱ score, and it was compared with the actual mortality to obtain the standard mortality, of which less than 0.9 was defined as an improved survival rate. Results  After 12 hours of CRRT treatment, all the variables (except mean arterial pressure and brain hemodynamics were significantly improved in the sepsis group (P<0.05. The survival rate in ICU was 60.7% with a standard mortality of 0.70. In the non-sepsis group, the survival rate in ICU was only 15.8% and the standard mortality was 1.77. Only the FiO2 was found to be significantly improved in the non-sepsis group. Conclusion  CRRT may significantly improve the clinical outcome and survival rate of patients with sepsis-caused MODS, but no obvious effect is found among the patients with MODS caused by non-sepsis factors.

  15. Therapeutic Drug Monitoring of Continuous Infusion Doripenem in a Pediatric Patient on Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Cies, Jeffrey J; Moore, Wayne S; Conley, Susan B; Shea, Paul; Enache, Adela; Chopra, Arun

    2017-01-01

    An 11-year-old African American male with severe combined immunodeficiency variant, non-cystic fibrosis bronchiectasis, pancreatic insufficiency, chronic mycobacterium avium-intracellulare infection, chronic sinusitis, and malnutrition presented with a 1-week history of fevers. He subsequently developed respiratory decompensation and cefepime was discontinued and doripenem was initiated. Doripenem was the carbapenem used due to a national shortage of meropenem. By day 7 the patient (24.7 kg) had a positive fluid balance of 6925 mL (28% FO), and on days 7 into 8 developed acute kidney injury evidenced by an elevated serum creatinine of 0.68 mg/dL, an increase from the baseline of 0.28 mg/dL. On day 9, the patient was initiated on continuous renal replacement therapy (CRRT) and the doripenem dosing was changed to a continuous infusion of 2.5 mg/kg/hr (60 mg/kg/day). Approximately 12.5 hours after the start of the doripenem a serum concentration was obtained, which was 4.01 mg/L corresponding to a clearance of 10.5 mL/min/kg. The pediatric dosing and pharmacokinetic data available for doripenem suggest a clearance estimate of 4.4 to 4.8 mL/min/kg, and the adult clearance estimate is 2.4 to 3.78 mL/min/kg. The calculated clearance in our patient of 10.5 mL/min/kg is over double the highest clearance estimate in the pediatric literature. This case demonstrates that doripenem clearance is significantly increased with CRRT in comparison with the published pediatric and adult data. An appropriate pharmacodynamic outcome (time that free drug concentration > minimum inhibitory concentration) can be achieved by continuous infusion doripenem with concurrent therapeutic drug monitoring.

  16. Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?

    Energy Technology Data Exchange (ETDEWEB)

    Kavanagh, Eoin C.; Ryan, Stephanie; McCourbrey, Siobhan; O' Connor, Rachel; Donoghue, Veronica [Children' s University Hospital, Department of Radiology, Dublin (Ireland); Awan, Atif [Children' s University Hospital, Department of Paediatrics, Dublin (Ireland)

    2005-03-01

    Renal parenchymal defects may be a consequence of urinary tract infections (UTI) in childhood. MRI is a non-radiation imaging modality compared with DMSA scanning. To compare DMSA with MRI for the detection of renal parenchymal defects in children presenting for radiological investigation after a first UTI. Both DMSA and MRI were performed at the same appointment in 37 children (aged 4 months-13 years; mean 4.5 years) with a history of UTI. Both planar and SPECT DMSA were performed. MRI of the kidneys employed axial and coronal T1-, T2- and fat-saturated T1-weighted (T1-W) sequences. Some children had imaging after IV contrast medium. The coronal fat-saturated T1-W sequence was the best sequence and it detected all the findings on MRI. MRI had a sensitivity of 77% and a specificity of 87% for the detection of a scarred kidney using DMSA as the gold standard. MRI diagnosed pyelonephritis in two children that had been interpreted as scarring on DMSA. Renal MRI using a single, coronal, fat-saturated T1-W sequence is a rapid, accurate and minimally invasive technique for the detection of renal scarring that does not employ ionizing radiation. (orig.)

  17. Application of model of incremental haemodialysis, based on residual renal function, at the initiation of renal replacement therapy

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    José L. Merino

    2017-01-01

    Conclusions: Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.

  18. Stabilized incidence of diabetic patients referred for renal replacement therapy in Denmark

    DEFF Research Database (Denmark)

    Sørensen, V R; Hansen, P M; Heaf, J;

    2006-01-01

    from The Danish National Registry; Report on Dialysis and Transplantation, where all patients actively treated for end-stage renal disease have been registered since 1990. The incidence of end-stage renal disease increased until 2001. Thereafter the incidence stabilized on 130 per million people (pmp...

  19. Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report

    NARCIS (Netherlands)

    Pippias, M.; Stel, V.S.; Diez, J.M. Abad; Afentakis, N.; Herrero-Calvo, J.A.; Arias, M.; Tomilina, N.; Caamano, E. Bouzas; Buturovic-Ponikvar, J.; Cala, S.; Caskey, F.J.; Nuez, P. Castro de la; Cernevskis, H.; Collart, F.; Torre, R. Alonso de la; Mde, L. Hoya; Meester, J. de; Diaz, J.M.; Djukanovic, L.; Alamar, M. Ferrer; Finne, P.; Garneata, L.; Golan, E.; Fernandez, R.; Avila, G. Gutierrez; Heaf, J.; Hoitsma, A.J.; Kantaria, N.; Kolesnyk, M.; Kramar, R.; Kramer, A.; Lassalle, M.; Leivestad, T.; Lopot, F.; Macario, F.; Magaz, A.; Martin-Escobar, E.; Metcalfe, W.; Noordzij, M.; Palsson, R.; Pechter, U.; Prutz, K.G.; Ratkovic, M.; Resic, H.; Rutkowski, B.; Pablos, C. Santiuste de; Spustova, V.; Suleymanlar, G.; Stralen, K. Van; Thereska, N.; Wanner, C.; Jager, K.J.

    2015-01-01

    BACKGROUND: This article summarizes the 2012 European Renal Association-European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as >/=65 years). METHODS: Data provided by 45 national or regional renal

  20. Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival-an analysis of data from the ERA-EDTA Registry.

    NARCIS (Netherlands)

    Spithoven, E.M.; Kramer, A.; Meijer, E.; Orskov, B.; Wanner, C.; Abad, J.M.; Areste, N.; Torre, R.A. de la; Caskey, F.; Couchoud, C.; Finne, P.; Heaf, J.; Hoitsma, A.J.; Meester, J. de; Pascual, J.; Postorino, M.; Ravani, P.; Zurriaga, O.; Jager, K.J.; Gansevoort, R.T.

    2014-01-01

    BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD. METHODS: This study used data from the ERA-EDTA Registry

  1. Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe : prevalence and survival-an analysis of data from the ERA-EDTA Registry

    NARCIS (Netherlands)

    Spithoven, Edwin M.; Kramer, Anneke; Meijer, Esther; Orskov, Bjarne; Wanner, Christoph; Abad, Jose M.; Areste, Nuria; Alonso de la Torre, Ramon; Caskey, Fergus; Couchoud, Cecile; Finne, Patrik; Heaf, James; Hoitsma, Andries; de Meester, Johan; Pascual, Julio; Postorino, Maurizio; Ravani, Pietro; Zurriaga, Oscar; Jager, Kitty J.; Gansevoort, Ron T.

    2014-01-01

    Background. Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD. Methods. This study used data from the ERA-EDTA Registry

  2. Clinical evolution of chronic renal patients with HIV infection in replacement therapy.

    Science.gov (United States)

    Saracho, Ramón; Martín Escobar, Eduardo; Comas Farnés, Jordi; Arcos, Emma; Mazuecos Blanca, Auxiliadora; Gentil Govantes, Miguel Ángel; Castro de la Nuez, Pablo; Zurriaga, Óscar; Ferrer Alamar, Manuel; Bouzas Caamaño, Encarnación; García Falcón, Teresa; Portolés Pérez, José; Herrero Calvo, José A; Chamorro Jambrina, Carlos; Moina Eguren, Íñigo; Rodrigo de Tomás, María Teresa; Abad Díez, José María; Sánchez Miret, José I; Alvarez Lipe, Rafael; Díaz Tejeiro, Rafael; Moreno Alía, Inmaculada; Torres Guinea, Marta; Huarte Loza, Enma; Artamendi Larrañaga, Marta; Fernández Renedo, Carlos; González Fernández, Raquel; Sánchez Álvarez, Emilio; Alonso de la Torre, Ramón

    2015-01-01

    Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Cost analysis of integrated renal replacement therapy program in the province of Toledo (2012-2013).

    Science.gov (United States)

    Conde Olasagasti, José L; Garcia Diaz, José Eugenio; Carrasco Benitez, Pilar; Mareque Ruiz, Miguel Ángel; Parras Partido, María Pilar; Moreno Alia, Inmaculada; Jimenez Lopez, Laura; Cia Lecumberri, Juan José; Araque, Pilar; Fernandez, María Luisa

    Renal replacement therapy (RRT) is the object of constant analysis in the search for efficiency and sustainability. To calculate the direct cost of healthcare for the prevalent RRT population in the province of Toledo (2012/2013). a) Population: All prevalent patients at some point in RRT in 2012 (669) and in 2013 (682). b) Costs included (€): 1) dialysis procedure; 2) inpatient, outpatient and emergency care, dialysis and non-dialysis related; 3) drug consumption; 4) medical transport. c) Calculation and analysis: The aggregate localized or reconstructed cost of each item was calculated from the individual cost of each patient. Annual cost and cost per patient/year was calculated for the whole RRT and for its subprograms (€). a) Aggregate costs: The total cost of RRT amounted to 15.84 and 15.77 million euros (2012/2013). Dialysis procedures account for 40.2% of the total while the sum of hospital care and drug consumption represents 41.5%. Healthcare for patients on hospital haemodialysis (HHD) and combined haemodialysis (CHD), peritoneal dialysis (PD) and transplant (Tx) accounts for 70.0, 5.0 and 25.0% of the total respectively. b) Patient/year cost: From the number of patients/year provided by each subprogramme, the following values were obtained in 2012/2013: All RRT 26,130/25,379; HHD 49,167/53,289; CHD 44,657/44,971; PD 45,538/51,869 and Tx 10,909/10,984. Our results are consistent with others published, although our patient/year values are slightly higher, probably because they include elements such as outpatient pharmacy, hospital and medical transport cargo. The growing contribution of Tx to the survival of the whole RRT population contains the overall costs and reduces the patient/year cost, making RRT sustainable. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Some Issues on Gender and Renal Replacement Therapy in Kano State, Nigeria: Implications for Development

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    Nuratu Muhammad

    2013-07-01

    Full Text Available The study examined some issues on Gender and renal replacement therapy (RRT in Kano state. Stratified sampling technique was used to select 46 males and 26 females from Aminu Kano teaching hospital (AKTH and Abdullah Wase or Nassarawa specialist hospital. Before embarking on data collection, ethical approval was sought and given by the ministry of health Kano state for Abdullah Wase hospital and the management of AKTH hospital. Data was derived primarily from the questionnaire administered to the selected samples, in addition hospital based records of patients were obtained from the dialysis unit of the two hospitals. The results of the study showed that both male and female patients delayed in RRT. However majority of the males and females delayed due to inadequate information(19% and(18% and lack of money(y25% and (18%for the male and female patients resulting from the low socio economic status of most of them as indicated in the tables on education and income of the respondents, Other factors that caused infrequent RRT included the long term nature of treatment (12% and (23%, tried out alternative treatment (19% and (18%males and females respectively. Some of the socio economic and psychological costs of RRT were found to include cut in social spending( 22% males and(15% females, increased expenditure on health (17% and( 19% ,frequent illness (22% and (31%, loss of job (4%males only ,decrease in number of hours put to work (30% and( 31% matrimonial problems ((4% and another ( 4%for the males and females respectively Based on the findings of this research it is recommended that government ad stakeholders need to redefine their priorities and place health matters as a top priority in all state matters as the saying goes a healthy nation is a wealthy nation. Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso

  5. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Xu, Xiaoying; Khadzhynov, Dmytro; Peters, Harm; Chaves, Ricardo L; Hamed, Kamal; Levi, Micha; Corti, Natascia

    2017-03-01

    The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno-venous haemodialysis (CVVHD; n = 9) and continuous veno-venous haemodiafiltration (CVVHDF; n = 8). Model-based simulations were performed to compare the 24 h AUC, Cmax and Cmin of daptomycin following various dosing regimens (4, 6, 8, 10, and 12 mg kg(-1) every [Q] 24 h and Q48 h), with the safety and efficacy exposure references for Staphylococcus aureus bacteraemia/right-sided infective endocarditis. The previously developed daptomycin structural population PK model could reasonably describe data from the patients on CRRT. The clearance in patients undergoing CVVHDF and CVVHD was estimated at 0.53 and 0.94 l h(-1) , respectively, as compared with 0.75 l h(-1) in patients with creatinine clearance (CrCl) ≥ 30 ml min(-1) . Daptomycin Q24 h dosing in patients undergoing CRRT resulted in optimal exposure for efficacy, with AUC comparable to that in patients with CrCl ≥ 30 ml min(-1) . In contrast, Q48 h dosing was associated with considerably lower AUC24-48h in all patients for doses up to 12 mg kg(-1) and is therefore inappropriate. Q24 h dosing of daptomycin up to 12 mg kg(-1) provides comparable drug exposure in patients on CVVHD and in those with CrCl ≥ 30 ml min(-1) . Daily daptomycin use up to 8 mg kg(-1) doses are appropriate for patients on CVVHDF, but higher doses may increase the risk of toxicity. © 2016 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

  6. Initiation time of renal replacement therapy on patients with acute kidney injury: A systematic review and meta-analysis of 8179 participants.

    Science.gov (United States)

    Wang, Caixia; Lv, Lin-Sheng; Huang, Hui; Guan, Jianqiang; Ye, Zengchun; Li, Shaomin; Wang, Yanni; Lou, Tanqi; Liu, Xun

    2017-01-01

    The early initiation of renal replacement therapy has been recommended for patients with acute renal failure by some studies, but its effects on mortality and renal recovery are unknown. We conducted an updated meta-analysis to provide quantitative evaluations of the association between the early initiation of renal replacement therapy and mortality for patients with acute kidney injury. After applying inclusion/exclusion criteria, 51 studies, including 10 randomized controlled trials, with a total of 8179 patients were analyzed. Analysis of the included trials showed that patients receiving early renal replacement therapy had a 25% reduction in all-cause mortality compared to those receiving late renal replacement therapy (risk ratio [RR] 0.75, 95% CI [0.69, 0.82]). We also noted a 30% increase in renal recovery (RR 1.30, 95% CI [1.07, 1.56]), a reduction in hospitalization of 5.84 days (mean difference [MD], 95% CI [-10.27, -1.41]) and a reduction in the duration of mechanical ventilation of 2.33 days (MD, 95% CI [-3.40, -1.26]) in patients assigned to early renal replacement therapy. The early initiation of renal replacement therapy was associated with a decreased risk of all-cause mortality compared with the late initiation of RRT in patients with acute kidney injury. These findings should be interpreted with caution given the heterogeneity between studies. Further studies are needed to identify the causes of mortality and to assess whether mortality differs by dialysis dose.

  7. Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

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    Odutola Israel Odetunde

    2014-01-01

    Full Text Available A 5-year observational, retrospective study was conducted to evaluate the indications, the availability, the accessibility, the sustainability, and the outcome of children managed for acute kidney injury (AKI and end stage kidney disease (ESKD who required renal replacement therapy RRT in Enugu, southeast Nigeria. A total of 64 patients aged 5 months to 16 years required RRT, of which only 25 underwent RRT, giving an RRT accessibility rate of 39.1%. Eleven (44% patients required chronic dialysis program/ renal transplant, of which only 1 (9.1% accessed and sustained chronic hemodialysis, giving a dialysis acceptance rate of 9.1%. Fifty (78% of the patients belonged to the low socioeconomic class. Thirty-three (51.5% could not access RRT because of financial constraints and discharge against medical advice (DAMA; 6 (9.4% died on admission while sourcing for funds to access the therapy; 5 (7.8% died while on RRT; 9 (14.1% improved and were discharged for follow-up; 1 (1.6% improved and was discharged to be on chronic dialysis program while awaiting renal transplantation outside the country/clinic follow-up, while the remaining 10 (15.6% were unable to sustain chronic dialysis program or access renal transplantation and were lost to follow-up. We conclude that RRT remains unaffordable within the subregion.

  8. Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study

    OpenAIRE

    Jiang SP; Zhu ZY; Wu XL; Lu XY; Zhang XG; Wu BH

    2014-01-01

    Sai-Ping Jiang,1 Zheng-Yi Zhu,2 Xiao-Liang Wu,3 Xiao-Yang Lu,1 Xing-Guo Zhang,1 Bao-Hua Wu1 1Department of Pharmacy, the First Affiliated Hospital, 2Department of Pharmacy, Children’s Hospital, College of Medicine, Zhejiang University, Hangzhou, 3Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China Background: The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated...

  9. Characteristics and outcomes of children with primary oxalosis requiring renal replacement therapy.

    NARCIS (Netherlands)

    Harambat, J.; Stralen, K.J. van; Espinosa, L.; Groothoff, J.W.; Hulton, S.A.; Cerkauskiene, R.; Schaefer, F.; Verrina, E.; Jager, K.J.; Cochat, P.; Hoitsma, A.J.; Hemke, A.C.

    2012-01-01

    BACKGROUND AND OBJECTIVES: Primary hyperoxaluria (PH) as a cause of ESRD in children is believed to have poor outcomes. Data on management and outcomes of these children remain scarce. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study included patients aged <19 years who started renal rep

  10. Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004 Perfil epidemiológico de los pacientes en terapia renal substitutiva en Brasil, 2000-2004 Epidemiological profile of patients on renal replacement therapy in Brazil, 2000-2004

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    Mariangela Leal Cherchiglia

    2010-08-01

    femenino, residentes en la región Norte y Noreste y sin transplante renal presentan mayor riesgo de muerte.OBJECTIVE: To describe the clinical and epidemiological profile of patients under renal replacement therapies, identifying risk factors for death. METHODS: This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministic-probabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS: The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%. The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the final Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a first modality and not having renal transplantation. CONCLUSIONS: There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and

  11. Therapeutic drug monitoring of continuous-infusion acylovir for disseminated herpes simplex virus infection in a neonate receiving concurrent extracorporeal life support and continuous renal replacement therapy.

    Science.gov (United States)

    Cies, Jeffrey J; Moore, Wayne S; Miller, Kyle; Small, Christine; Carella, Dominick; Conley, Susan; Parker, Jason; Shea, Paul; Chopra, Arun

    2015-02-01

    Disseminated herpes simplex virus (HSV) infection in neonates represents a devastating entity that yields high mortality. Acyclovir is the primary antiviral agent used to treat life-threatening HSV infections in neonates; however, even though the agent has reduced morbidity overall from these infections, mortality with disseminated disease remains high. Currently, to our knowledge, no data exist regarding therapeutic drug monitoring of acyclovir in the setting of extracorporeal life support (ECLS) or continuous renal replacement therapy (CRRT) coupled with ECLS. We describe the case of a 14-day-old female with disseminated HSV-1 infection that progressed to fulminant hepatic and renal failure, necessitating the use of ECLS for hemodynamic support and CRRT as a treatment modality for hepatic and renal failure. The standard dosage of acyclovir 20 mg/kg/dose intravenously every 8 hours had been initiated, but after conversion to ECLS and CRRT, the patient's dosage was increased to 30 mg/kg/dose every 8 hours. After a repeat viral load remained unchanged from the initial viral load at 1 × 10(8)  copies/ml, the patient was transitioned from intermittent dosing to a continuous infusion of acyclovir added to the dialysate solution for CRRT at a concentration of 5.5 mg/L. To provide an optimal outcome, dosing was designed to maintain acyclovir plasma concentrations of at least 3 mg/L in order to maintain an acyclovir concentration of at least 1 mg/L in the cerebrospinal fluid. The patient's acyclovir serum concentrations measured at 24 and 72 hours after starting continuous-infusion acyclovir via the dialysate were 8.8 and 5.3 mg/L, respectively, allowing for a continuous serum concentration above 3 mg/L. Unfortunately, before a repeat viral load could be obtained to assess the efficacy of the continuous infusion acyclovir, the patient experienced an intracerebral hemorrhage as a complication related to ECLS after which technological support was withdrawn

  12. Renal replacement therapy in Europe—a summary of the 2010 ERA–EDTA Registry Annual Report

    Science.gov (United States)

    Kramer, Anneke; Stel, Vianda S.; Abad Diez, José Maria; Alonso de la Torre, Ramón; Bouzas Caamaño, Encarnación; Čala, Svjetlana; Cao Baduell, Higini; Castro de la Nuez, Pablo; Cernevskis, Harijs; Collart, Frederic; Couchoud, Cécile; de Meester, Johan; Djukanovic, Ljubica; Ferrer-Alamar, Manuel; Finne, Patrik; Fogarty, Damian; de los Ángeles García Bazaga, María; Garneata, Liliana; Golan, Eliezer; Gonzalez Fernández, Raquel; Heaf, James G.; Hoitsma, Andries; Ioannidis, George A.; Kolesnyk, Mykola; Kramar, Reinhard; Leivestad, Torbjørn; Limido, Aurelio; Lopot, Frantisek; Macario, Fernando; Magaz, Ángela; Martín-Escobar, Eduardo; Metcalfe, Wendy; Noordzij, Marlies; Ots-Rosenberg, Mai; Palsson, Runolfur; Piñera, Celestino; Postorino, Maurizio; Prutz, Karl G.; Ratkovic, Marina; Resic, Halima; Rodríguez Hernández, Aurelio; Rutkowski, Boleslaw; Serdengeçti, Kamil; Yebenes, Tomas Sierra; Spustová, Viera; Stojceva-Taneva, Olivera; Tomilina, Natalia A.; van de Luijtgaarden, Moniek W.M.; van Stralen, Karlijn J.; Wanner, Christoph; Jager, Kitty J.

    2013-01-01

    Background This study provides a summary of the 2010 European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) Registry Annual Report (available at www.era-edta-reg.org). Methods This report includes data on renal replacement therapy (RRT) using data from the national and regional renal registries in 29 countries in Europe and bordering the Mediterranean Sea. Individual patient data were received from 27 registries, whereas 18 registries contributed data in aggregated form. We present incidence and prevalence of RRT, transplant rates, survival probabilities and expected remaining lifetimes. The latter two are solely based on individual patient records. Results In 2010, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA–EDTA Registry was 123 per million population (pmp) (n = 91 798). The highest incidence rate was reported by Turkey (252pmp) and the lowest reported by Montenegro (21 pmp). The overall prevalence of RRT for ESRD at 31 December 2010 among all registries reporting to the ERA–EDTA Registry was 741 pmp (n = 551 005). The prevalence varied from 124 pmp in Ukraine to 1580 pmp in Portugal. The overall number of renal transplantations performed in 2010 among all registries was 29.2 pmp (n = 21 740). The highest overall transplant rate was reported from Spain, Cantabria (73 pmp), whereas the highest transplant rate for living donor kidneys was reported from the Netherlands (28 pmp). For patients who started RRT between 2001 and 2005, the unadjusted 5-year patient survival on RRT was 46.2% [95% confidence interval (CI) 46.0–46.3], and on dialysis 38.6% (95% CI 38.5–38.8). The unadjusted 5-year patient survival after the first renal transplantation performed between 2001 and 2005 was 86.6% (95% CI 86.1–87.1) for deceased donor kidneys and 94.1% (95% CI 93.4–94.8) for living donor kidneys. PMID:27818766

  13. Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients

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    Nicanor Vega-Diaz

    2015-07-01

    Full Text Available Background: In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD, a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF in patients on peritoneal dialysis (PD is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD patients, with end-stage renal disease (ESRD secondary to diabetic nephropathy (DN in comparison to non-diabetic nephropathy (NDN, using different PD solutions in combination. Design: Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. Results: The fraction of renal urea clearance (Kt relative to distribution volume (V (or total body water (Kt/V, or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively, and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively. Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0

  14. The Impact of Macro-and Micronutrients on Predicting Outcomes of Critically Ill Patients Requiring Continuous Renal Replacement Therapy.

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    Kittrawee Kritmetapak

    Full Text Available Critically ill patients with acute kidney injury (AKI who receive renal replacement therapy (RRT have very high mortality rate. During RRT, there are markedly loss of macro- and micronutrients which may cause malnutrition and result in impaired renal recovery and patient survival. We aimed to examine the predictive role of macro- and micronutrients on survival and renal outcomes in critically ill patients undergoing continuous RRT (CRRT. This prospective observational study enrolled critically ill patients requiring CRRT at Intensive Care Unit of King Chulalongkorn Memorial Hospital from November 2012 until November 2013. The serum, urine, and effluent fluid were serially collected on the first three days to calculate protein metabolism including dietary protein intake (DPI, nitrogen balance, and normalized protein catabolic rate (nPCR. Serum zinc, selenium, and copper were measured for micronutrients analysis on the first three days of CRRT. Survivor was defined as being alive on day 28 after initiation of CRRT.Dialysis status on day 28 was also determined. Of the 70 critically ill patients requiring CRRT, 27 patients (37.5% survived on day 28. The DPI and serum albumin of survivors were significantly higher than non-survivors (0.8± 0.2 vs 0.5 ±0.3g/kg/day, p = 0.001, and 3.2±0.5 vs 2.9±0.5 g/dL, p = 0.03, respectively while other markers were comparable. The DPI alone predicted patient survival with area under the curve (AUC of 0.69. A combined clinical model predicted survival with AUC of 0.78. When adjusted for differences in albumin level, clinical severity score (APACHEII and SOFA score, and serum creatinine at initiation of CRRT, DPI still independently predicted survival (odds ratio 4.62, p = 0.009. The serum levels of micronutrients in both groups were comparable and unaltered following CRRT. Regarding renal outcome, patients in the dialysis independent group had higher serum albumin levels than the dialysis dependent group, p = 0

  15. Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties with Acute Kidney Injury

    Science.gov (United States)

    2008-02-01

    compromise. This, in turn, leads to suboptimal delivery of dialysis; in fact, a number of patients were not offered hemodialysis because of concerns as to...criteria. None were placed on hemodialysis . The other control patients either recovered their renal func- tion and later died of other causes or died before...31 Although the data may still not be definitive , we agree with the notion that the best evidence to date supports the use of at least 35 mL/kg/h for

  16. Continuous Renal Replacement Therapy: Reviewing Current Best Practice to Provide High-Quality Extracorporeal Therapy to Critically Ill Patients.

    Science.gov (United States)

    Connor, Michael J; Karakala, Nithin

    2017-07-01

    Continuous renal replacement therapy (CRRT) use continues to expand globally. Despite improving technology, CRRT remains a complex intervention. Delivery of high-quality CRRT requires close collaboration of a multidisciplinary team including members of the critical care medicine, nephrology, nursing, pharmacy, and nutrition support teams. While significant gaps in medical evidence regarding CRRT persist, the growing evidence base supports evolving best practice and consensus to define high-quality CRRT. Unfortunately, there is wide variability in CRRT operating characteristics and limited uptake of these best practices. This article will briefly review the current best practice on important aspects of CRRT delivery including CRRT dose, anticoagulation, dialysis vascular access, fluid management, and drug dosing in CRRT. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  17. The activity of antioxidant enzymes in blood platelets in different types of renal replacement therapy: a cross-sectional study.

    Science.gov (United States)

    Stępniewska, Joanna; Dołęgowska, Barbara; Cecerska-Heryć, Elżbieta; Gołembiewska, Edyta; Malinowska-Jędraszczyk, Alicja; Marchelek-Myśliwiec, Małgorzata; Ciechanowski, Kazimierz

    2016-04-01

    The changes in redox status characterise physiological platelet activation. Increased oxidative stress in chronic kidney disease (CKD) associated with uremic toxicity and procedures of renal replacement therapy leads to the impairment of antioxidant properties of platelets. It may contribute to thrombosis and cardiovascular complications increasing morbidity and mortality among the CKD patients. The object of the research was to assess the influence of conservative treatment, peritoneal dialysis and haemodialysis on platelet prooxidative-antioxidative balance. The examined group consisted of 122 patients: 37 on regular haemodialysis (HD), 23 on peritoneal dialysis (PD) and 62 on conservative treatment with CKD stages 3-5 (CKD3-5). The activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), glutathione transpherase (GST) in platelets were obtained using kinetic methods. The spectrophotometric method established the concentrations of reduced glutathione (GSH). SOD activity in PD differs significantly from CKD3-5 (4.96 vs 1.66; p activity assessed in PD and CKD3-5 was significantly different from HD (0.82 and 0.8 vs 0.52 before and 0.35 after HD, respectively). GST activity reached the highest value in PD (1.62), and it was significantly different from CKD3-5 (0.23) and HD before haemodialysis (0.11). During haemodialysis therapy, there was a considerable increase in GST activity (0.11 vs 0.3; p = 0.02) and decrease in SOD activity (from 3.41 to 2.27; p = 0.01). The highest GSH concentrations were obtained in CKD3-5 and differ significantly from HD (4.12 vs 2.01; p = 0.02). The type of treatment, age and duration of renal replacement therapy determined significant changes in platelet antioxidative enzymes activities and concentration of GSH, which may enhance the thrombotic complications. PD is associated with lower platelet oxidative stress.

  18. Fluconazole dosing predictions in critically-ill patients receiving prolonged intermittent renal replacement therapy: a Monte Carlo simulation approach.

    Science.gov (United States)

    Gharibian, Katherine N; Mueller, Bruce A

    2016-07-01

    Fluconazole is a renally-eliminated antifungal commonly used to treat Candida species infections. In critically-ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic (PK) data are available to guide fluconazole dosing. We used previously-published fluconazole clearance data and PK data of critically-ill patients with acute kidney injury to develop a PK model with the goal of determining a therapeutic dosing regimen for critically-ill patients receiving PIRRT. Monte Carlo simulations were performed to create a virtual cohort of patients receiving different fluconazole dosing regimens. Plasma drug concentration-time profiles were evaluated on the probability of attaining a mean 24-hour area under the drug concentration-time curve to minimum inhibitory concentration ratio (AUC24h : MIC) of 100 during the initial 48 hours of antifungal therapy. At the susceptibility breakpoint of Candida albicans (2 mg/L), 93 - 96% of simulated subjects receiving PIRRT attained the pharmacodynamic target with a fluconazole 800-mg loading dose plus 400 mg twice daily (q12h or pre and post PIRRT) regimen. Monte Carlo simulations of a PK model of PIRRT provided a basis for the development of an informed fluconazole dosing recommendation when PK data was limited. This finding should be validated in the clinical setting.

  19. Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Han Soo Park

    2017-03-01

    Full Text Available Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF. A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED. She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

  20. Influence of Daily Fluid Balance prior to Continuous Renal Replacement Therapy on Outcomes in Critically Ill Patients.

    Science.gov (United States)

    Han, Min Jee; Park, Ki Hyun; Shin, Jung-Ho; Kim, Su Hyun

    2016-08-01

    Positive fluid balance is a risk factor for mortality in critically ill patients, especially those requiring continuous renal replacement therapy (CRRT). However, the association between daily fluid balance and various organ impairments remains unclear. This study investigated the impacts of daily fluid balance prior to CRRT on organ dysfunction, as well as mortality in critically ill patients. We identified daily fluid balance between intensive care unit (ICU) admission and CRRT initiation. According to daily fluid balance, the time to CRRT initiation and the rate of organ failure based on the sequential organ failure assessment (SOFA) score were assessed. We recruited 100 patients who experienced CRRT for acute kidney injury. CRRT was initiated within 2 [0, 4] days. The time to CRRT initiation was shortened in proportion to daily fluid balance, even after the adjustment for the renal SOFA score at ICU admission (HR 1.14, P = 0.007). Based on the SOFA score, positive daily fluid balance was associated with respiratory, cardiovascular, nervous, and coagulation failure, independent of each initial SOFA score at ICU admission (HR 1.36, 1.26, 1.24 and 2.26, all P balance was related with an increase in the rate of 28-day mortality (HR 1.14, P = 0.012). Positive daily fluid balance may accelerate the requirement for CRRT, moreover, it can be associated with an increased risk of multiple organ failure in critically ill patients.

  1. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis.

    Science.gov (United States)

    Heintz, Brett H; Matzke, Gary R; Dager, William E

    2009-05-01

    Infectious diseases and impaired renal function often occur in critically ill patients, and delaying the start of appropriate empiric antimicrobial therapy or starting inappropriate therapy has been associated with poor outcomes. Our primary objective was to critically review and discuss the influence of chronic kidney disease (CKD) and acute kidney injury (AKI) on the clinical pharmacokinetic and pharmacodynamic properties of antimicrobial agents. The effect of continuous renal replacement therapies (CRRTs) and intermittent hemodialysis (IHD) on drug disposition in these two populations was also evaluated. Finally, proposed dosing strategies for selected antimicrobials in critically ill adult patients as well as those receiving CRRT or IHD have been compiled. We conducted a PubMed search (January 1980-March 2008) to identify all English-language literature published in which dosing recommendations were proposed for antimicrobials commonly used in critically ill patients, including those receiving CRRT or IHD. All pertinent reviews, selected studies, and associated references were evaluated to ensure their relevance. Forty antimicrobial, antifungal, and antiviral agents commonly used in critically ill patients were included for review. Dosage recommendations were synthesized from the 42 reviewed articles and peer-reviewed, evidence-based clinical drug databases to generate initial guidance for the determination of antimicrobial dosing strategies for critically ill adults. Because of the evolving process of critical illness, whether in patients with AKI or in those with CKD, prospective adaptation of these initial dosing recommendations to meet the needs of each individual patient will often rely on prospectively collected clinical and laboratory data.

  2. How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy?

    Science.gov (United States)

    Jamal, Janattul-Ain; Mueller, Bruce A; Choi, Gordon Y S; Lipman, Jeffrey; Roberts, Jason A

    2015-05-01

    Determining appropriate antibiotic dosing for critically ill patients receiving renal replacement therapy (RRT) is complex. Worldwide unstandardized and heterogeneous prescribing of RRT as well as altered patient physiology and pathogen susceptibility all cause drug disposition to be much different to that seen in non-critically ill patients. Significant changes to pharmacokinetic parameters, including volume of distribution and clearance, could be expected, in particular, for antibiotics that are hydrophilic with low plasma protein binding and that are usually primarily eliminated by the renal system. Antibiotic clearance is likely to be significantly increased when higher RRT intensities are used. The combined effect of these factors that alter antibiotic disposition is that non-standard dosing strategies should be considered to achieve therapeutic exposure. In particular, an aggressive early approach to dosing should be considered and this may include administration of a 'loading dose', to rapidly achieve therapeutic concentrations and maximally reduce the inoculum of the pathogen. This approach is particularly important given the pharmacokinetic changes in the critically ill as well as the increased likelihood of less susceptible pathogens. Dose individualization that applies knowledge of the RRT and patient factors causing altered pharmacokinetics remains the key approach for ensuring effective antibiotic therapy for these patients. Where possible, therapeutic drug monitoring should also be used to ensure more accurate therapy. A lack of pharmacokinetic data for antibiotics during the prolonged intermittent RRT and intermittent hemodialysis currently limits evidence-based antibiotic dose recommendations for these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Quality of life assessed with the medical outcomes study short form 36-item health survey of patients on renal replacement therapy: A systematic review and meta-analysis

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina); J.L. Bosch (Johanna); L.R. Arends (Lidia); M.H. Heijenbrok-Kal (Majanka); M.G.M. Hunink (Myriam)

    2007-01-01

    textabstractObjectives: The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) is the most widely used generic instrument to estimate quality of life of patients on renal replacement therapy. Purpose of this study was to summarize and compare the published literature on quality of life

  4. Quality of life assessed with the medical outcomes study short form 36-item health survey of patients on renal replacement therapy: A systematic review and meta-analysis

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina); J.L. Bosch (Johanna); L.R. Arends (Lidia); M.H. Heijenbrok-Kal (Majanka); M.G.M. Hunink (Myriam)

    2007-01-01

    textabstractObjectives: The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) is the most widely used generic instrument to estimate quality of life of patients on renal replacement therapy. Purpose of this study was to summarize and compare the published literature on quality of

  5. Pilot Study of the Pharmacokinetics of Cefotaxime in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

    NARCIS (Netherlands)

    Koedijk, Joost B.; Valk-Swinkels, Corinne G. H.; Rijpstra, Tom A.; Touw, Daan J.; Mulder, Paul G. H.; Van Der Voort, Peter H. J.; Van 't Veer, Nils E.; Van Der Meer, Nardo J. M.

    2016-01-01

    The objective of this study was to describe the pharmacokinetics of cefotaxime (CTX) in critically ill patients with acute kidney injury (AKI) when treated with continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). This single-center prospective observational pilot study was

  6. A case of severe chlorite poisoning successfully treated with early administration of methylene blue, renal replacement therapy, and red blood cell transfusion: case report.

    Science.gov (United States)

    Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H; Yaghi, Aktham

    2014-08-01

    The case of a 55-year-old man who attempted suicide by ingesting blue (10% after 29 hours).To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent.This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells.

  7. Evaluation of the Frequency and Related Factors of Depression and Anxiety in Patients with End Stage Renal Disease Receiving Renal Replacement Therapies

    Directory of Open Access Journals (Sweden)

    Bennur ESEN

    2015-12-01

    Full Text Available OBJECTIVE: Anxiety and depression are frequently observed among patients on renal replacement therapy (RRT. Our aim is to evaluate the frequency of depression and anxiety and their association with laboratory parameters, disease activity, performance status and sociodemographic properties of patients receiving hemodialysis (HD or peritoneal dialysis (PD. MATERIAL and METHODS: Laboratory parameters and socio-demographic features of 77 patients on PD and 83 patients on HD were recorded. The psychological status of patients was evaluated with the Beck Anxiety-Depression Scale and the performance status was determined with the Karnofsky Scale. RESULTS: There was no significant difference between the groups in terms of the frequency and severity of depression and anxiety. The percentage of patients with a university graduate degree, monthly income > 600 TL, and social insurance were significantly higher in the PD group (p<0.01. The frequency of depression was 2.66 times higher among female subjects p:0.02. In the HD group, the frequency of depression in patients with anxiety was 4.74 times higher than in patients without anxiety. CONCLUSION: The present study showed that anxiety and depression are prevalent in patients receiving RRT and especially in female patients and university degree graduates. However, the frequencies were similar between patients on PD and HD. Patients on RRT should be monitored.

  8. Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease.

    Science.gov (United States)

    Kalantar-Zadeh, Kamyar; Crowley, Susan T; Beddhu, Srinivasan; Chen, Joline L T; Daugirdas, John T; Goldfarb, David S; Jin, Anna; Kovesdy, Csaba P; Leehey, David J; Moradi, Hamid; Navaneethan, Sankar D; Norris, Keith C; Obi, Yoshitsugu; O'Hare, Ann; Shafi, Tariq; Streja, Elani; Unruh, Mark L; Vachharajani, Tushar J; Weisbord, Steven; Rhee, Connie M

    2017-05-01

    Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6000 dialysis units nationwide, there are currently approximately 70 Veterans Affairs (VA) dialysis centers. Given this number of VA dialysis centers and their limited capacity, only 10% of all incident dialysis Veterans initiate treatment in a VA center. Evidence suggests that, among Veterans, the receipt of care within the VA system is associated with favorable outcomes, potentially because of the enhanced access to healthcare resources. Data from the United States Renal Data System Special Study Center "Transition-of-Care-in-CKD" suggest that Veterans who receive dialysis in a VA unit exhibit greater survival compared with the non-VA centers. Substantial financial expenditures arise from the high volume of outsourced care and higher dialysis reimbursement paid by the VA than by Medicare to outsourced providers. Given the exceedingly high mortality and abrupt decline in residual kidney function (RKF) in the first dialysis year, it is possible that incremental transition to dialysis through an initial twice-weekly hemodialysis regimen might preserve RKF, prolong vascular access longevity, improve patients' quality of life, and be a more patient-centered approach, more consistent with "personalized" dialysis. Broad implementation of incremental dialysis might also result in more Veterans receiving care within a VA dialysis unit. Controlled trials are needed to examine the safety and efficacy of incremental hemodialysis in Veterans and other populations; the administrative and health care as well as provider structure within the VA system would facilitate the performance of such trials. © 2017 Wiley Periodicals, Inc.

  9. [Infectious complications in children with end-stage renal disease on replacement therapy].

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    Robles-Vázquez, Néstor Daniel; Aguilar-Kitsu, María Alejandra; Mendoza-Guevara, Leticia; Miranda-Novales, María Guadalupe

    2015-01-01

    Introducción: aproximadamente 5000 niños menores de 20 años y 200 menores de dos años inician anualmente tratamiento para enfermedad renal terminal (ERT). Se buscó estimar la incidencia de complicaciones infecciosas en niños con ERT en terapia sustitutiva. Métodos: cohorte retrospectiva, se incluyeron pacientes en los programas de diálisis peritoneal y hemodiálisis, con seguimiento mínimo de tres meses. Se calculó la densidad de incidencia para las infecciones asociadas a terapia sustitutiva. Resultados: se analizaron 67 pacientes. En 88 % la terapia inicial fue diálisis peritoneal. Se presentaron 52 eventos de peritonitis y la densidad de incidencia fue de 0.63 episodios/paciente por año. Treinta niños (48 %) nunca tuvieron peritonitis. A los seis meses de seguimiento 90 % de los niños continuaban con el mismo catéter, lo cual disminuyó a 84, 74 y 50 % a los 12, 18 y 24 meses, respectivamente. Cuarenta y cinco niños estuvieron en hemodiálisis, 82 % de ellos precedidos por diálisis peritoneal. El tiempo en hemodiálisis en 25 % fue mayor a 19 meses. Se presentaron 22 eventos de bacteriemia y la densidad de incidencia fue 1 episodio/1000 días-catéter ó 2.5/1000 sesiones de hemodiálisis. Se trasplantaron 29 pacientes (43 %), dos fallecieron. La mediana de espera para trasplante fue de 15 meses. Conclusiones: la incidencia de complicaciones infecciosas es similar a lo registrado en la literatura. A los 20 meses, la mitad de los pacientes tuvieron al menos una complicación infecciosa.

  10. Heart valve replacement for patients with end-stage renal disease in Japan.

    Science.gov (United States)

    Misawa, Yoshio

    2010-08-01

    There is some controversy regarding the choice of prosthetic valves in patients with heart disease and concomitant end-stage renal disease requiring chronic dialysis. Dialysis patients tend to have a short life expectancy. In Japan, the 1-year survival of the dialysis patients was 80% in the 1980s, but exceeds 85% in the 2000s. The 5-year survival has been 54%-60% for the past 20 years. In addition, the 10-year and 15-year survivals have been 35%-42% and 23%-31%, respectively. However, in the United States, the 5-year survival had only improved to 35% among patients who started dialysis between 1996 and 2000, and the life expectancies of chronic dialysis patients in their sixth, seventh and eighth decades is 5.3-6.2 years, 3.8-4.5 years, and 2.7-3.2 years, respectively. The life expectancy of dialysis patients in Japan is thus better than that of patients in the United States. Some surgeons prefer to use bioprosthetic valves because of a high rate of hemorrhagic complications in dialysis patients. They are hesitant to use anticoagulation therapy in dialysis patients with mechanical valves. Others prefer mechanical valves because of the potential for early structural dysfunction of bioprosthetic valves implanted in the dialysis patients with abnormal calcium metabolism, which can cause calcium deposition on the bioprosthetic valves during the early postoperative period. The life expectancy of dialysis patients in Japan is relatively high. The potential risk of early calcification of bioprosthetic valves should be taken into account when choosing prosthetic heart valves for these patients in Japan.

  11. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

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    Garcia-Fernandez Nuria

    2009-09-01

    Full Text Available Abstract Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI. Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.

  12. Increased SOCS expression in peripheral blood mononuclear cells of end stage renal disease patients is related to inflammation and dialysis modality.

    Science.gov (United States)

    Rastmanesh, M Mehdi; Braam, Branko; Joles, Jaap A; Boer, Peter; Bluyssen, Hans A R

    2009-01-05

    Inflammation is a characteristic of cardiovascular disease and is increased in end-stage renal disease. Suppressors of cytokine signaling (SOCS) inhibit and reflect activation of intracellular inflammatory pathways. We hypothesized that SOCS expression in peripheral blood mononuclear cells of end stage renal disease patients is increased. Whether SOCS expression in peripheral blood mononuclear cells is related to inflammation, dialysis, and dialysis modality was investigated. Monocytes and lymphocytes were isolated from peripheral blood mononuclear cells of patients not on dialysis (n=8), on peritoneal dialysis (n=8), on hemodialysis (n=14) and of healthy control (n=15) subjects. SOCS expression was assessed by real-time quantitative PCR and plasma cytokines by ELISA. In end stage renal disease patients monocyte SOCS1, and lymphocyte SOCS1 and cytokine-inducible SH2 containing protein-1 (CIS-1) gene expression were increased along with increased plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF)alpha ,and C-reactive protein (CRP). Monocyte SOCS1 correlated with IL-6. Lymphocyte CIS-1 was increased in non-dialysis and peritoneal dialysis but not in hemodialysis patients. Lymphocyte CIS-1 in peritoneal dialysis patients correlated with plasma TNFalpha. Despite the relatively low number of patients studied we observed increased expression of SOCS1 in both monocytes and lymphocytes, and of CIS-1 solely in lymphocytes of the patients. SOCS expression was related to increased systemic inflammation, illustrated by a significant correlation between monocyte SOCS1 and plasma IL-6. SOCS expression in peripheral blood mononuclear cells was also affected by hemodialysis, indicated by increased lymphocyte CIS-1 in non-dialysis and peritoneal dialysis but not in hemodialysis patients. We suggest that increased SOCS expression in peripheral blood mononuclear cells of end stage renal disease patients reflects whether and to which extent systemic inflammation

  13. One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease.

    Science.gov (United States)

    O'Hair, Daniel P; Bajwa, Tanvir K; Chetcuti, Stanley J; Deeb, G Michael; Stoler, Robert C; Hebeler, Robert F; Maini, Brijeshwar; Mumtaz, Mubashir; Kleiman, Neal S; Reardon, Michael J; Li, Shuzhen; Adams, David H; Watson, Daniel R; Yakubov, Steven J; Popma, Jeffrey J; Petrossian, George

    2017-05-01

    End-stage renal disease (ESRD) poses unique challenges in the treatment of patients with severe aortic stenosis. Although surgical valve replacement in ESRD patients has been associated with increased mortality, the outcomes from transcatheter aortic valve replacement (TAVR) are not clearly defined. The CoreValve US Expanded Use Study is a prospective, nonrandomized study of TAVR in extreme-risk patients with comorbidities excluding them from the Pivotal Trial. We report on patients with ESRD. The primary endpoint was a composite of all-cause mortality or major stroke at 1 year. Ninety-six patients with ESRD underwent TAVR with the CoreValve (Medtronic, Minneapolis, MN) and have reached 1-year follow-up. Mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 16.2% ± 8.4%. The rate of all-cause mortality or major stroke at 1 year was 30.3%. The all-cause mortality rate was 5.3% at 30 days and 30.3% at 1 year. The rate at 1 year of any stroke or transient ischemic attack was 2.1%; major vascular injury was 5.2%; and new permanent pacemaker was 26.8%. Valve performance improved postprocedure and remained improved at 1 year (effective orifice area 1.71 cm(2), mean gradient 9.33 mm Hg) CONCLUSIONS: Early mortality in patients with ESRD is comparable to previously published data on extreme-risk patients without ESRD, but our data suggest a higher mortality rate at 1 year for ESRD patients, likely due to comorbid conditions. Stroke and major vascular injury are infrequent, and improved valve hemodynamics are maintained at 1 year. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Higher Prevalence of Klebsiella pneumoniae Extended-Spectrum β-Lactamase in Patients on Renal Replacement Therapy.

    Science.gov (United States)

    Lee, Hyang-Lim; Whang, Dong-Hee; Park, Dong-Won; Lee, Young-Jin; Kim, Yeong-Hoon; Chin, Ho-Jun; Kim, Suhnggown; Koo, Ho-Seok

    2013-08-01

    The prevalence of antibiotic resistance is higher in patients undergoing renal replacement therapy (RRT) than in patients who did not undergo RRT. We investigated the presence of KP (Klebsiella pneumoniae) in patients who underwent RRT. All data were collected retrospectively by accessing patient medical records from 2004 to 2011 for the culture results of all patients who were positive for KP. We grouped the patients by the presence of extended-spectrum β-lactamase (ESBL) into a KP ESBL(-) group (KP[-]) and a KP ESBL(+) group (KP[+]). In total, 292 patients (23.1%) were in the KP(+) group, and 974 patients (76.9%) were in the KP(-) group. A greater percentage of KP(+) was found in patients who underwent RRT (7.5%) than in patients who did not undergo RRT (3.2%) (OR, 2.479; 95% CI,1.412-4.352). A Cox's hazard proportional model analysis was performed, and for patients with pneumonia, the risk of KP(+) was 0.663 times higher in patients who had lower albumin levels, 2.796 times higher in patients who had an inserted Levin tube, and 4.551 times higher in patients who underwent RRT. In conclusion, RRT can be a risk factor for KP(+) in patients with pneumonia.

  15. Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy

    Science.gov (United States)

    Passos, Rogério da Hora; Ramos, Joao Gabriel Rosa; Gobatto, André; Mendonça, Evandro José Bulhões; Miranda, Eva Alves; Dutra, Fábio Ricardo Dantas; Coelho, Maria Fernanda R; Pedroza, Andrea C; Batista, Paulo Benigno Pena; Dutra, Margarida Maria Dantas

    2016-01-01

    Abstract The aim of the study was to assess the clinical utility of lactate measured at different time points to predict mortality at 48 hours and 28 days in septic patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Consecutive critically ill patients with septic AKI requiring CRRT were prospectively studied. Variables were collected at initiation of CRRT and 24 hours later. In total, 186 patients were analyzed. Overall mortality at 48 hours was 28% and at 28 days was 69%. Initial lactate, lactate at 24 hours and the proportion of patients with a lactate clearance superior to 10% were different between survivors at 28 days [2.0 mmol/L, 1.95 mmol/L and 18/45 (40%)] and nonsurvivors [3.46 mmol, 4.66 mmol, and 18/94 (19%)]. Multivariate analysis demonstrated that lactate at 24 hours and lactate clearance, but not initial lactate, were independently associated to mortality. Area under the ROC curves for 28-day mortality was 0.635 for initial lactate; 0.828 for lactate at 24 hours and 0.701 for lactate clearance. Lactate clearance and lactate after 24 hours of CRRT, but not initial lactate, were independently associated with mortality in septic AKI patients undergoing CRRT. Serial lactate measurements may be useful prognostic markers than initial lactate in these patients. PMID:27749594

  16. Amino Acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy.

    Science.gov (United States)

    Btaiche, Imad F; Mohammad, Rima A; Alaniz, Cesar; Mueller, Bruce A

    2008-05-01

    Acute kidney injury in critically ill patients is often a complication of an underlying condition such as organ failure, sepsis, or drug therapy. In these patients, stress-induced hypercatabolism results in loss of body cell mass. Unless nutrition support is provided, malnutrition and negative nitrogen balance may ensue. Because of metabolic, fluid, and electrolyte abnormalities, optimization of nutrition to patients with acute kidney injury presents a challenge to the clinician. In patients treated with conventional intermittent hemodialysis, achieving adequate amino acid intake can be limited by azotemia and fluid restriction. With the use of continuous renal replacement therapy (CRRT), however, better control of azotemia and liberalization of fluid intake allow amino acid intake to be maximized to support the patient's metabolic needs. High amino acid doses up to 2.5 g/kg/day in patients treated with CRRT improved nitrogen balance. However, to our knowledge, no studies have correlated increased amino acid intake with improved outcomes in critically ill patients with acute kidney injury. Data from large, prospective, randomized, controlled trials are needed to optimize the dosing of amino acids in critically ill patients with acute kidney injury who are treated with CRRT and to study the safety of high doses and their effects on patient morbidity and survival.

  17. Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation.

    Science.gov (United States)

    Jamal, Janattul-Ain; Economou, Caleb J P; Lipman, Jeffrey; Roberts, Jason A

    2012-10-01

    Antibiotic dosing for critically ill patients that is derived from other patient groups is likely to be suboptimal because of significant antibiotic pharmacokinetic changes, particularly in terms of drug volume of distribution and clearance. Organ support techniques including renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) increase the pharmacokinetic variability. This article reviews the recently published antibiotic pharmacokinetic data associated with burns patients, those receiving continuous RRT (CRRT), sustained low-efficiency dialysis (SLED) and ECMO. These groups develop increases in volume of distribution that necessitate the use of higher initial doses to rapidly achieve therapeutic antibiotic concentrations. Burns patients have supranormal drug clearances requiring more frequent administration of antibiotics. Patients receiving CRRT or SLED have variable drug clearances related to different equipment and RRT settings at different institutions. ECMO presents a different challenge because there is such a dearth of data with higher than standard doses potentially required, even in the presence of end-organ failure. In the context of such variable pharmacokinetics, a guideline approach to dosing remains elusive because of insufficient available data and, therefore, use of therapeutic drug monitoring should be considered advantageous where possible.

  18. Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure.

    Science.gov (United States)

    Pschowski, R; Briegel, S; Von Haehling, S; Doehner, W; Bender, T O; Pape, U F; Hasper, D; Jörress, A; Schefold, J C

    2015-11-01

    Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P dialysis-dependent acute renal failure in this regard.

  19. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis.

    Science.gov (United States)

    Brain, Matthew; Winson, Elizabeth; Roodenburg, Owen; McNeil, John

    2017-02-20

    Optimising filter life and performance efficiency in continuous renal replacement therapy has been a focus of considerable recent research. Larger high quality studies have predominantly focussed on optimal anticoagulation however CRRT is complex and filter life is also affected by vascular access, circuit and management factors. We performed a systematic search of the literature to identify and quantify the effect of vascular access, circuit and patient factors that affect filter life and presented the results as a meta-analysis. A systematic review and meta-analysis was performed by searching Pubmed (MEDLINE) and Ovid EMBASE libraries from inception to 29(th) February 2016 for all studies with a comparator or independent variable relating to CRRT circuits and reporting filter life. Included studies documented filter life in hours with a comparator other than anti-coagulation intervention. All studies comparing anticoagulation interventions were searched for regression or hazard models pertaining to other sources of variation in filter life. Eight hundred nineteen abstracts were identified of which 364 were selected for full text analysis. 24 presented data on patient modifiers of circuit life, 14 on vascular access modifiers and 34 on circuit related factors. Risk of bias was high and findings are hypothesis generating. Ranking of vascular access site by filter longevity favours: tunnelled semi-permanent catheters, femoral, internal jugular and subclavian last. There is inconsistency in the difference reported between femoral and jugular catheters. Amongst published literature, modality of CRRT consistently favoured continuous veno-venous haemodiafiltration (CVVHD-F) with an associated 44% lower failure rate compared to CVVH. There was a trend favouring higher blood flow rates. There is insufficient data to determine advantages of haemofilter membranes. Patient factors associated with a statistically significant worsening of filter life included mechanical

  20. The effect of different apheresis modalities on coagulation factor XIII level during antibody removal in ABO-blood type incompatible living related renal transplantation.

    Science.gov (United States)

    Hanafusa, Norio; Hamasaki, Yoshifumi; Kawarasaki, Hiroo; Kido, Ryo; Shibagaki, Yugo; Ishikawa, Akira; Enomoto, Yutaka; Fujita, Toshiro; Noiri, Eisei; Nangaku, Masaomi

    2013-10-01

    Apheresis therapy is used to remove pathogenic antibodies within the recipient blood during ABO-incompatible living related renal transplantation (LRRT). Factor XIII (FXIII) is a coagulating factor. Its deficiency reportedly engenders perioperative bleeding. This study compared apheresis modalities from the perspective of the FXIII level. Cases 1-3 were treated only with double-filtration plasmapheresis (DFPP) without (case 1) or with (cases 2 and 3) fresh frozen plasma (FFP) supplementation. Cases 4 and 5 were treated with simple plasma exchange (PEx) with FFP supplementation for the last session. Cases 1-3 showed a marked (case 1, 8.6%) or moderate (case 2, 26.2%; case 3, 28.4%) decrease in FXIII on the day before the procedure after the last apheresis session, although cases 4 (81.9%) and 5 (66.2%) did not. Case 1 experienced perioperative bleeding. The last session is usually performed the day before the surgical procedure. Therefore, FXIII elimination by DFPP might cause bleeding complications because of its slow recovery. The fact warrants that the last apheresis modality during the course might be PEx from the viewpoint of FXIII depletion.

  1. Antibiotic dosing in critically ill patients with septic shock and on continuous renal replacement therapy: can we resolve this problem with pharmacokinetic studies and dosing guidelines?

    OpenAIRE

    Roberts, Jason A; Roberts, Darren M.

    2014-01-01

    Dosing antibiotics in critically ill patients to achieve therapeutic concentrations is a significant challenge. The presence of septic shock and prescription of continuous renal replacement therapy introduces further complexities for the clinician. Unfortunately, this is a dilemma encountered daily by intensivists. Although small pharmacokinetic studies are emerging to provide data to help address this problem, the variability in results from these studies is profound. As such, effective anti...

  2. High-Dose Estradiol-Replacement Therapy Enhances the Renal Vascular Response to Angiotensin II via an AT2-Receptor Dependent Mechanism

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    Tahereh Safari

    2015-01-01

    Full Text Available Physiological levels of estrogen appear to enhance angiotensin type 2 receptor- (AT2R- mediated vasodilatation. However, the effects of supraphysiological levels of estrogen, analogous to those achieved with high-dose estrogen replacement therapy in postmenopausal women, remain unknown. Therefore, we pretreated ovariectomized rats with a relatively high dose of estrogen (0.5 mg/kg/week for two weeks. Subsequently, renal hemodynamic responses to intravenous angiotensin II (Ang II, 30–300 ng/kg/min were tested under anesthesia, while renal perfusion pressure was held constant. The role of AT2R was examined by pretreating groups of rats with PD123319 or its vehicle. Renal blood flow (RBF decreased in a dose-related manner in response to Ang II. Responses to Ang II were enhanced by pretreatment with estradiol. For example, at 300 ng kg−1 min−1, Ang II reduced RBF by 45.7±1.9% in estradiol-treated rats but only by 27.3±5.1% in vehicle-treated rats. Pretreatment with PD123319 blunted the response of RBF to Ang II in estradiol-treated rats, so that reductions in RBF were similar to those in rats not treated with estradiol. We conclude that supraphysiological levels of estrogen promote AT2R-mediated renal vasoconstriction. This mechanism could potentially contribute to the increased risk of cardiovascular disease associated with hormone replacement therapy using high-dose estrogen.

  3. End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?

    Science.gov (United States)

    Condado, Jose F; Maini, Aneel; Leshnower, Bradley; Thourani, Vinod; Forcillo, Jessica; Devireddy, Chandan; Mavromatis, Kreton; Sarin, Eric L; Stewart, James; Guyton, Robert; Simone, Amy; Keegan, Patricia; Lerakis, Stamatios; Block, Peter C; Babaliaros, Vasilis

    2017-05-01

    Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed. Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=<0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95%CI 1.002-1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95%CI 1.595-9.840), but dialysis duration and type, and SAVR versus TAVR were not. Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD. © 2016 Wiley Periodicals, Inc. © 2016 Wiley

  4. Evaluation of sulfobutylether-β-cyclodextrin (SBECD) accumulation and voriconazole pharmacokinetics in critically ill patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Kiser, Tyree H; Fish, Douglas N; Aquilante, Christina L; Rower, Joseph E; Wempe, Michael F; MacLaren, Robert; Teitelbaum, Isaac

    2015-02-03

    Intravenous (IV) voriconazole is not recommended in patients with creatinine clearance 50 ml/min to avoid potentially toxic accumulation of sulfobutylether-β-cyclodextrin (SBECD). The purpose of this study was to evaluate the pharmacokinetics of SBECD, voriconazole, and voriconazole N-oxide in critically ill patients undergoing continuous renal replacement therapy (CRRT) and to determine if CRRT removes SBECD sufficiently to allow for the use of IV voriconazole without significant risk of SBECD accumulation. This prospective, open-label pharmacokinetic study enrolled patients >18 years old receiving IV voriconazole for a known or suspected invasive fungal infection while undergoing CRRT. Serial blood and effluent samples were collected on days 1, 3, 5, 7, and every 3 to 5 days thereafter. SBECD, voriconazole, and voriconazole N-oxide plasma and effluent concentrations were measured by liquid chromatography-tandem mass spectrometry. Pharmacokinetic, pharmacodynamic, and pharmacogenetic analyses were conducted. Ten patients (mean ± standard deviation (SD)) 53 ± 11 years old, 50% male, 81 ± 14 kg, with Acute Physiologic and Chronic Health Evaluation II (APACHE II) scores of 31.5 ± 3.8 were evaluated. All patients underwent continuous venovenous hemofiltration (CVVH) with a median predilution replacement fluid rate of 36 (interquartile range (IQR) 32 to 37) ml/kg/hr and total ultrafiltration rate of 38 (IQR 34 to 39) ml/kg/hr. Mean ± SD voriconazole and SBECD dosages administered were 8.1 ± 2.1 mg/kg/day and 129 ± 33 mg/kg/day, respectively. Voriconazole plasma trough concentrations were >1 mg/L in all patients with CVVH accounting for only 15% of the total body clearance. CVVH accounted for 86% of the total body clearance of SBECD with the majority of the dose being recovered in the effluent. Minimal increases in dose normalized SBECD area under the concentration-time curve from 0 to 12 hours (AUC0-12) (4,484 ± 4,368 to 4,553

  5. Anticoagulação em terapias contínuas de substituição renal Anticoagulation in continuous renal replacement therapies (CRRT

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    Erwin Otero Garcés

    2007-10-01

    Full Text Available As terapias contínuas de substituição renal (TSRC são comumente usadas na maioria de pacientes criticamente enfermos com indicação de diálise. O sucesso das TSRC depende de um protocolo de anticoagulação eficiente para manter permeável o circuito de diálise, minimizando complicações como sangramento por anticoagulação excessiva ou a necessidade da troca do sistema por coagulação do mesmo, por anticoagulação insuficiente. Vários fatores podem contribuir para a trombose do circuito de diálise, como a velocidade do fluxo de sangue através do circuito, o cateter de diálise, o tipo de membrana utilizada no filtro dialisador e, também, o tipo de terapia prescrita. A heparina não fracionada (HNF é o anticoagulante mais utilizado para as diferentes técnicas de diálise e, mais recentemente, as heparinas de baixo peso molecular (HBPM têm se mostrado seguras e efetivas para TRSC. Em pacientes criticamente enfermos que freqüentemente têm contra-indicação para anticoagulação sistêmica, existe a alternativa da anticoagulção regional com citrato trissódico, método eficiente e seguro, se aplicado com controle metabólico estrito. A anticoagulação regional com HNF/protamina tem seu uso limitado, atualmente, por apresentar muitas complicações decorrentes de efeitos adversos da protamina. Na impossibilidade do paciente ser anticoagulado, ou se a anticoagulação regional com citrato não for disponível, a lavagem freqüente do circuito de diálise com solução salina é a única alternativa aplicável. Novas drogas ainda não disponíveis no Brasil, como prostaglandinas, hirudina recombinante, argatroban e nafamostat podem ser utilizadas em pacientes com contra-indicação para heparinização.Continuous renal replacement therapies (CRRT are commonly used in the majority of critically ill patients who need dialysis. Treatment success depends on an efficient anticoagulation protocol devised to maintain the dialysis

  6. Seroprevalance of the Hepatitis B and C in Patients with Chronic Kidney Disease without History of Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Serhan PİŞKİNPAŞA

    2013-05-01

    Full Text Available OBJECTIVE: Hepatitis B (HBV and hepatitis C (HCV viruses are significant causes of morbidity and mortality in patients with chronic kidney disease (CKD. There is insufficient data on seroprevalence of HBV and HCV in CKD patients without renal replacement therapy (RRT. MATERIAL and METHODS: Patients diagnosed as having CKD without RRT were analyzed. Seven hundred and eighty cases included study. RESULTS: The seroprevalence of HbsAg and Anti-HCV were 3.5% and 1.3%, respectively. The seroprevalence of Anti-HBsAb analyzed in 456 (58.4% patients was 39.3%. The seroprevalence of HBsAg and Anti-HCV did not differ between the patients in early stage (stage 3 and advanced stage CKD (Stage 4 and 5 (p=0.26 and p=0.88, respectively. Seropositivity of Anti-HBsAb was 41.9% in early stage and 33.6% in advanced stage CKD (p=0.88. No difference was detected in seroprevalence of HbsAg and Anti-HCV when patients were grouped regarding the underlying disorders of CKD (p=0.95 and p=0.25, respectively. CONCLUSION: Higher seroprevalence of Anti-HCV in hemodialysis patients, according to studies carried out in our country, may be secondary to the exposure to HCV during hemodialysis procedure. High seropositivity of Anti-HBsAb in early stage CKD, although not statistically significant, may point out the necessity of hepatitis B immunization earlier in the course of CKD. Screening the patients with CKD without RRT for HBsAg and Anti-HCV serologies would be applicable although there is no established consensus in guidelines.

  7. Body mass index is inversely associated with mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

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    Hyoungnae Kim

    2017-03-01

    Full Text Available Background: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT. Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. Methods: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. Results: Patients were categorized into three groups according to tertiles of body mass index (BMI. During ≥30 days after the initiation of CRRT, 39 patients (57.4% in the highest tertile died, as compared with 58 patients (78.4% in the lowest tertile (P = 0.02. In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01. This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03 and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03. Conclusion: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.

  8. Pharmacokinetics of Continuous Infusion Meropenem With Concurrent Extracorporeal Life Support and Continuous Renal Replacement Therapy: A Case Report.

    Science.gov (United States)

    Cies, Jeffrey J; Moore, Wayne S; Conley, Susan B; Dickerman, Mindy J; Small, Christine; Carella, Dominick; Shea, Paul; Parker, Jason; Chopra, Arun

    2016-01-01

    Pharmacokinetic parameters can be significantly altered for both extracorporeal life support (ECLS) and continuous renal replacement therapy (CRRT). This case report describes the pharmacokinetics of continuous-infusion meropenem in a patient on ECLS with concurrent CRRT. A 2.8-kg, 10-day-old, full-term neonate born via spontaneous vaginal delivery presented with hypothermia, lethargy, and a ~500-g weight loss from birth. She progressed to respiratory failure on hospital day 2 (HD 2) and developed sepsis, disseminated intravascular coagulation, and liver failure as a result of disseminated adenoviral infection. By HD 6, acute kidney injury was evident, with progressive fluid overload >1500 mL (+) for the admission. On HD 6 venoarterial ECLS was instituted for lung protection and fluid removal. On HD 7 she was initiated on CRRT. On HD 12, a blood culture returned positive and subsequently grew Pseudomonas aeruginosa with a minimum inhibitory concentration (MIC) for meropenem of 0.25 mg/L. She was started on vancomycin, meropenem, and amikacin. A meropenem bolus of 40 mg/kg was given, followed by a continuous infusion of 10 mg/kg/hr (240 mg/kg/day). On HD 15 (ECLS day 9) a meropenem serum concentration of 21 mcg/mL was obtained, corresponding to a clearance of 7.9 mL/kg/min. Repeat cultures from HDs 13 to 15 (ECLS days 7-9) were sterile. This meropenem regimen was successful in providing a target attainment of 100% for serum concentrations above the MIC for ≥40% of the dosing interval and was associated with a sterilization of blood in this complex patient on concurrent ECLS and CRRT circuits.

  9. Effect of regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy rewarming in dogs with accidental hypothermia

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    Rui YUAN

    2016-10-01

    Full Text Available Objective  To observe the influences of regional citrate or systemic heparin anticoagulation on acid-base balance, coagulation, electrolytes, serum creatinine, alanine aminotransferase (ALT and cardiac index (CI during continuous renal replacement therapy (CRRT rewarming in accidental hypothermia dogs. Methods  Nineteen adult beagles were given abdominal trauma coupled with deep hypothermia [(28±0.5℃] induced by seawater immersion for establishing animal model of trauma. According to rewarming ways, the animal models were randomly divided into three groups, comparison group (warm bath rewarming, n=5, CRRT rewarming-systemic heparin anticoagulation group (heparin anticoagulation group, n=7 and CRRT rewarming-regional citrate anticoagulation group (citrate anticoagulation group, n=7. During the rewarming routine blood examination was performed, and blood chemistry, coagulation function, blood gas and hemodynamic status were assayed, at the same time the mortality was recorded. Results  During the rewarming, the mortality was 14.3% (1/7 in heparin anticoagulation group, 40.0% (2/5 in warm bath group and 0 in regional citrate anticoagulation group. Blood temperature in creased to 38℃, the heparin anticoagulation group showed a significant decrease of platelet compared with citrate anticoagulation group and comparison group (P0.05. Conclusions  CRRT plus warm bath rewarming have better effect on improving metabolic acidosis than warm bath rewarming alone in accidental hypothermia dogs. In comparison with systemic heparin anticoagulation, regional citrate anticoagulation has smaller influences on coagulation system and platelet when CRRT rewarming performed in accidental hypothermia dogs. DOI: 10.11855/j.issn.0577-7402.2016.10.05

  10. Peritoneal dialysis catheter placement as a mode of renal replacement therapy: Long-term results from a tertiary academic institution.

    Science.gov (United States)

    Haskins, Ivy N; Schreiber, Martin; Prabhu, Ajita S; Krpata, David M; Perez, Arielle J; Tastaldi, Luciano; Tu, Chao; Rosen, Michael J; Rosenblatt, Steven

    2017-08-31

    Peritoneal dialysis as a mode of renal replacement therapy still has not been embraced widely as an alternative to hemodialysis. Furthermore, there is marked variability in peritoneal dialysis catheter insertion techniques and perioperative management within the United States. After the publication of best-demonstrated practices for peritoneal dialysis catheter placement, the utilization of peritoneal dialysis has increased significantly at our institution. We detail the long-term success of peritoneal dialysis catheter placement after the adoption of best-demonstrated practices. Retrospective chart review was performed on all patients who underwent laparoscopic peritoneal dialysis catheter placement using the best-demonstrated practice technique from January 2005 through December 2015. Preoperative patient demographic information, intraoperative variables, 30-day morbidity and mortality, and long-term catheter durability outcomes were investigated. A total of 457 patients met inclusion criteria. Four (0.9%) patients experienced an immediate postoperative complication requiring return to the operating room. There were no perioperative mortalities. A total of 298 (65.2%) patients were available for long-term follow-up; 221 (74.2%) patients are still alive, 76 (25.6%) patients are still undergoing peritoneal dialysis, 63 (21.1%) patients transitioned from peritoneal dialysis to hemodialysis, and 88 (29.5%) patients have undergone kidney transplantation. Based on Kaplan-Meier survival plots, 30% of patients will transition from peritoneal dialysis to hemodialysis after 5.5 years of peritoneal dialysis and the median time from commencing peritoneal dialysis to kidney transplantation is 5.6 years. Based on our institutional data, the adoption of best-demonstrated practices should provide long-term and reliable access to the peritoneal cavity. We recommend the adoption of these techniques to facilitate long-term peritoneal dialysis catheter survival. Copyright © 2017

  11. Pharmacokinetics of meropenem during intermittent and continuous intravenous application in patients treated by continuous renal replacement therapy.

    Science.gov (United States)

    Langgartner, Julia; Vasold, Antje; Glück, Thomas; Reng, Michel; Kees, Frieder

    2008-06-01

    The clinical effect of beta-lactam antibiotics depends on the time of drug concentration above the minimal inhibitory concentration (MIC) for a susceptible bacterium. Continuous infusion (CI) of beta-lactams such as meropenem may therefore be a more rational approach than intermittent bolus injections (IB). The aim of this study was to test whether CI of meropenem achieves effective drug concentrations comparable to IB in patients treated by continuous renal replacement therapy (CRRT). Prospective, randomised cross-over study. Twelve-bed medical intensive care unit (ICU). Six ICU patients were randomised to receive either meropenem 1 g IB every 12 h or a 0.5 g i.v. loading dose followed by 2 g i.v. CI over 24 h. After 2 days, regimens were crossed over. Meropenem pharmacokinetics were determined on days 2 and 4. Peak serum concentration [median (25% and 75% quartiles)] after short infusion of 1 g meropenem were 62.8 (51.4; 85.0) mg/l, trough levels at 12 h were 8.1 (4.5; 18.7) mg/l, and serum half-life was 5.3 (5.1; 7.0) h. Steady-state concentrations during CI were 18.6 (13.3; 24.5) mg/l. The AUCs during either treatment were comparable and determined as 233 (202; 254) mg/l*h (IB) and 227 (182; 283) mg/l*h (CI), respectively. Four hours after IB, drug concentrations dropped below CI steady-state concentrations. Appropriate antibacterial concentrations of meropenem in patients with CRRT are easily achievable with CI. CI may be an effective alternative dosing regimen to IB. A prospective comparison of the clinical efficacy of the two dosage regimens is warranted.

  12. Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study.

    Science.gov (United States)

    Jiang, Sai-Ping; Zhu, Zheng-Yi; Wu, Xiao-Liang; Lu, Xiao-Yang; Zhang, Xing-Guo; Wu, Bao-Hua

    2014-01-01

    The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98%) of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81%) were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10%) were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, Pdosing adjustment, which was 8.93 days vs 7.68 days (P=0.26) and 30.10% vs 27.36% (P=0.39), respectively. Pharmacist dosing adjustment for patients receiving CRRT was well accepted by physicians, and was related with lower adverse drug event rates and ICU cost savings. These results may support the development of strategies to include a pharmacist in the multidisciplinary ICU team.

  13. Impact of pharmacist antimicrobial dosing adjustments in septic patients on continuous renal replacement therapy in an intensive care unit.

    Science.gov (United States)

    Jiang, Sai-Ping; Zhu, Zheng-Yi; Ma, Kui-Fen; Zheng, Xia; Lu, Xiao-Yang

    2013-12-01

    Correct dosing of antimicrobial drugs in septic patients receiving continuous renal replacement therapy (CRRT) is complex. This study aimed to evaluate the effects of dosing adjustments performed by pharmacists on the length of intensive care unit (ICU) stay, ICU cost, and antimicrobial adverse drug events (ADEs). A single-center, 2-phase (pre-/post-intervention) study was performed in an ICU of a university-affiliated hospital. Septic patients receiving CRRT in the post-intervention phase received a specialized antimicrobial dosing service from critical care pharmacists, whereas patients in the pre-intervention phase received routine medical care without involving pharmacists. The 2 phases were compared to evaluate the outcomes of pharmacist interventions. Pharmacists made 183 antimicrobial dosing adjustment recommendations for septic patients receiving CRRT. Changes in CRRT-related variables (116, 63.4%) were the most common risk factors for dosing errors, and β-lactams (101, 55.2%) were the antimicrobials most commonly associated with dosing errors. Dosing adjustments were related to a reduced length of ICU stay from 10.7 ± 11.1 days to 7.7 ± 8.3 days (p = 0.037) in the intervention group, and to cost savings of $3525 (13,463 ± 12,045 vs. 9938 ± 8811, p = 0.038) per septic patient receiving CRRT in the ICU. Suspected antimicrobial adverse drug events in the intervention group were significantly fewer than in the pre-intervention group (19 events vs. 8 events, p = 0.048). The involvement of pharmacists in antimicrobial dosing adjustments in septic patients receiving CRRT is associated with a reduced length of ICU stay, lower ICU costs, and fewer ADEs. Hospitals may consider employing clinical pharmacists in ICUs.

  14. Population pharmacokinetics of piperacillin and tazobactam in critically ill patients undergoing continuous renal replacement therapy: application to pharmacokinetic/pharmacodynamic analysis.

    Science.gov (United States)

    Asín-Prieto, Eduardo; Rodríguez-Gascón, Alicia; Trocóniz, Iñaki F; Soraluce, Amaia; Maynar, Javier; Sánchez-Izquierdo, José Ángel; Isla, Arantxazu

    2014-01-01

    To evaluate the pharmacokinetics of piperacillin/tazobactam in critically ill patients undergoing continuous renal replacement therapy (CRRT) and to assess the success of the therapy against susceptible bacteria. Sixteen patients undergoing CRRT with different degrees of renal function were included in the study. Blood and ultrafiltrate samples were drawn after administration of piperacillin/tazobactam (4/0.5 g) every 4, 6 or 8 h. The data were analysed by a population approach using NONMEM 7.2. The probability of target attainment (PTA) of maintaining free piperacillin levels above the MIC during the entire dosing interval was estimated by simulation of intermittent and continuous infusions. The pharmacokinetics of piperacillin and tazobactam were best described by two-compartment models where the elimination of both drugs was conditioned by renal [dependent on creatinine clearance (CLCR)], non-renal and extracorporeal clearances. A 20 min infusion of piperacillin/tazobactam administered every 6 h provided high PTAs against MICs ≤ 32 mg/L in patients with severe renal failure. In patients with normal or moderate renal function PTAs ≥ 90% were only obtained up to MICs ≤ 8 mg/L with short infusions. However, simulating continuous infusion, higher probabilities of success were obtained against MICs of 32 and 16 mg/L when CLCR was 50 and 100 mL/min, respectively. Population pharmacokinetic models have been developed and validated for piperacillin and tazobactam. Based on the pharmacokinetic/pharmacodynamic analysis, dosing recommendations are given considering the residual renal function of the patient and the MIC for the isolated bacteria.

  15. Review of combination of peritoneal dialysis and hemodialysis as a modality of treatment for end-stage renal disease.

    Science.gov (United States)

    Fukui, H; Hara, S; Hashimoto, Y; Horiuchi, T; Ikezoe, M; Itami, N; Kawabe, M; Kawanishi, H; Kimura, H; Nakamoto, Y; Nakayama, M; Ono, M; Ota, K; Shinoda, T; Suga, T; Ueda, T; Fujishima, M; Maeba, T; Yamashita, A; Yoshino, Y; Watanabe, S

    2004-02-01

    Because the contribution of residual renal function (RRF) to total solute clearance is often significant in continuous ambulatory peritoneal dialysis (CAPD), loss of RRF over time can lead to inadequate dialysis if appropriate prescription management strategies are not pursued. Additionally, declines in ultrafiltration caused by increases in peritoneal permeability may limit continuation of CAPD therapy. Peritoneal dialysis and hemodialysis (PD + HD) combination therapy (complementary dialysis therapy) is an alternative method. This therapy allows the patient to maintain daily activities, as with CAPD, while undergoing once-a-week HD supplements for the insufficient removal of solutes and water. This therapy allows for the continuation of PD without shifting to total HD in PD patients who continue to have uremic symptoms even after individualization of the PD prescription. This treatment option is psychologically more acceptable to patients and may be expected to provide such accompanying beneficial effects as peritoneal resting, improvement of QOL and reduction in medical cost.

  16. A Qualitative Assessment of Mismatch Between Dialysis Modality Selection and Initiation.

    Science.gov (United States)

    Ziolkowski, Susan; Liebman, Scott

    2016-01-01

    At our institution, we have noted that end-stage renal disease patients choosing a home dialysis modality after education often initiate renal replacement therapy with in-center hemodialysis (HD) instead. We interviewed 24 such patients (23 choosing peritoneal dialysis [PD], one choosing home HD) to determine reasons for this mismatch. The most common reasons cited for not starting home dialysis were: lack of confidence/concerns about complications, lack of space or home-related issues, a feeling of insufficient education, and perceived medical or social contraindications. We propose several potential strategies to help patients start with their preferred modality.

  17. Is proBNP a Reliable Marker for the Evaluation of Fluid Load in Patients Undergoing Continuous Renal Replacement Therapy?

    Directory of Open Access Journals (Sweden)

    Seher Erdogan

    2016-11-01

    Full Text Available Aim: Pro-B type natriuretic peptide (proBNP has been defined as a volume marker in hemodialysis patients. In the present study we aimed to evaluate the role of serum proBNP levels to indicate fluid load in patients undergoing continuous renal replacement therapy (CRRT due to overhydration. Material and Method: Patients who were admitted to a tertiary 7-bed pediatric intensive care unit and underwent CRRT due to overhydration were included in the study. Results: The study was conducted with 15 girls (53.6% and 13 boys (46.4%. The mean age was 61.46±56.13 months (range, 2-183 months; the mean CRRT administration time was 20.8±14.9 hours (range, 5-60 hours; and the mean percentage of fluid extracted from the body was 8.43 ± 4.51% (range, 2.5-20%. CRRT was administered to 12 patients because of fluid overload (42.9% and to 12 (57.1% because of fluid load accompanied by uremia.. There was a statistically significant difference between body weight, urea, and creatinine levels of patients before and after treatment (p= 0.001. The mean proBNP level was 23.306 ± 13.943 pg/mL immediately before CRRT and the mean proBNP after CRRT was 22.178 ± 15.473 pg/mL. There was no statistically significant difference between the initial and final proBNP levels (p= 0.756. With the exception of serum sodium levels, there was no correlation between the final proBNP levels and body weight, urea, and creatinine (p>0.05. Similarly, there was also no correlation between initial proBNP levels and fluid load (p= 0.602 or between the percentage of extracted fluid and final proBNP levels (p= 0.155. Discussion: There was no significant correlation between the fluid load and initial proBNP levels or with the extracted fluid percentage and final proBNP levels in patients undergoing CRRT because of fluid overload.In conclusion, no appropriate marker was determined to evaluate cumulative fluid load and the extracted liquid volume.

  18. Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study

    Directory of Open Access Journals (Sweden)

    Jiang SP

    2014-06-01

    Full Text Available Sai-Ping Jiang,1 Zheng-Yi Zhu,2 Xiao-Liang Wu,3 Xiao-Yang Lu,1 Xing-Guo Zhang,1 Bao-Hua Wu1 1Department of Pharmacy, the First Affiliated Hospital, 2Department of Pharmacy, Children’s Hospital, College of Medicine, Zhejiang University, Hangzhou, 3Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China Background: The impact of continuous renal replacement therapy (CRRT on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. Methods: A comparative study was conducted in an intensive care unit (ICU of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. Results: The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98% of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81% were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10% were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, P<0.001. However, there was no significant difference between length of ICU stay and mortality after pharmacist dosing adjustment, which

  19. A Case of Severe Chlorite Poisoning Successfully Treated With Early Administration of Methylene Blue, Renal Replacement Therapy, and Red Blood Cell Transfusion

    Science.gov (United States)

    Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H.; Yaghi, Aktham

    2014-01-01

    Abstract The case of a 55-year-old man who attempted suicide by ingesting sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum. Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours). To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent. This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells. PMID:25144325

  20. Incidence and characteristics of chronic renal replacement therapy in patients with cancer: data from kidney and cancer registries in Basse-Normandie.

    Science.gov (United States)

    Béchade, Clémence; Dejardin, Olivier; Bara, Simona; Bouvier, Véronique; Guizard, Anne-Valérie; De Mil, Rémy; Troussard, Xavier; Lobbedez, Thierry; Launoy, Guy

    2016-11-04

    Aims To estimate the incidence of chronic dialysis in patients with a history of cancer and assess how renal replacement therapy is initiated in this population. Methods We merged data from cancer registries and hospital databases in one French region to identify patients with an incident cancer between 2001 and 2008 who started chronic dialysis. Results Mean participation time was 3.4 ± 2.7 years. Males comprised 58.5 % of participants. During the study period, 74 chronic dialysis treatments were initiated. Chronic interstitial nephritis was the leading cause of end-stage renal disease (21.6 %), and 46.6 % of dialysis initiation cases were unplanned. The incidence rate of chronic dialysis initiation in the population of incident cancer patients was 370 per million population/year (74 events/199,809 person-years). After age-adjustment, the standardized incidence ratio was 1.26, 95 % confidence interval 0.98-1.57, p = 0.55. Conclusion Cancer patients are known to be at risk of chronic kidney disease. However, the standardized incidence ratio of chronic dialysis initiation did not differ significantly between cancer patients and the general population. Further studies should be performed to identify the barriers to starting renal replacement therapy in cancer patients.

  1. Transfusion requirements and clinical outcome in intensive care patients receiving continuous renal replacement therapy: comparison of prostacyclin vs. heparin prefilter administration

    DEFF Research Database (Denmark)

    Windeløv, Nis Agerlin; Ostrowski, Sisse R; Perner, Anders;

    2010-01-01

    Prostacyclin (PGI(2)) analogous are potent antithrombotics recommended as prefilter infusion during renal replacement therapy (RRT) when heparin is contraindicated. It is debated whether PGI(2) administration during RRT affects transfusion requirements and outcome. Retrospective cohort study of a...... intravascular coagulation (DIC) (P=0.006), severe thrombocytopenia (P=0.03), higher maximum Sequential Organ Failure Assessment score (P......: before, during and after CRRT. For each time period, laboratory values were analysed as changes/day and blood transfusion requirements as absolute values. Organ failures during the ICU stay and 1 year all-cause mortality were registered. During CRRT the PGI(2) group had a higher incidence of disseminated...

  2. Transfusion requirements and clinical outcome in intensive care patients receiving continuous renal replacement therapy: comparison of prostacyclin vs. heparin prefilter administration

    DEFF Research Database (Denmark)

    Windeløv, Nis Agerlin; Ostrowski, Sisse R; Perner, Anders;

    2010-01-01

    Prostacyclin (PGI(2)) analogous are potent antithrombotics recommended as prefilter infusion during renal replacement therapy (RRT) when heparin is contraindicated. It is debated whether PGI(2) administration during RRT affects transfusion requirements and outcome. Retrospective cohort study of all...... patients at a general intensive care unit (ICU) receiving continuous RRT (CRRT) in a 14-month period. Patients were stratified according to the used anticoagulant, that is prefilter PGI(2) group (n=24) and prefilter heparin group (n=70). The ICU stay of the patients was divided into three time periods...

  3. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study.

    Science.gov (United States)

    Parienti, Jean-Jacques; Mégarbane, Bruno; Fischer, Marc-Olivier; Lautrette, Alexandre; Gazui, Nicole; Marin, Nathalie; Hanouz, Jean-Luc; Ramakers, Michel; Daubin, Cédric; Mira, Jean-Paul; Charbonneau, Pierre; du Cheyron, Damien

    2010-04-01

    To compare dialysis catheter function according to catheter site. Multicenter, open, randomized controlled trial. Nine university-affiliated hospitals and three general hospitals in France. Seven hundred thirty-six patients in intensive care units who required a first venous catheterization to perform either intermittent hemodialysis (470 patients with 1275 sessions) or continuous renal replacement therapy (266 patients with 1003 days). Patients randomly received either femoral (n = 370) or jugular (n = 366) catheterization. For the jugular site, right-side position (n = 252) was recommended. Time to catheter ablation for dysfunction, urea reduction ratio (intermittent hemodialysis), and downtime (continuous renal replacement therapy) were assessed for all participants and evaluated by randomly assigned catheterization site (femoral or jugular). Baseline demography and dialysis prescriptions were similar between the site arms. In modified intent-to-treat, catheter dysfunction occurred in 36 of 348 (10.3%) and 38 of 342 (11.1%) patients in the femoral and jugular groups, respectively. The risk of catheter dysfunction did not significantly differ between randomized groups (hazard ratio, 1.06; 95% confidence interval, 0.67-1.68; p = .80). Compared to the femoral site, the observed risk of dysfunction decreased in the right jugular position (15 of 226; 6.6%; adjusted hazard ratio, 0.58; 95% confidence interval, 0.31-1.07; p = .09) and significantly increased in the left jugular position (23 of 118; 19.5%; adjusted hazard ratio, 1.89; 95% confidence interval, 1.12-3.21; p hemodialysis mean urea reduction ratio per session was 50.8% (standard deviation, 16.1) for femoral vs. 52.8% (standard deviation, 15.8) for jugular (p = .30) sites, and the median continuous renal replacement therapy downtime per patient-day was 1.17 hrs (interquartile range, 0.75-1.50) for both sites (p = .98). In terms of catheter dysfunction and dialysis performance among critically ill adults

  4. Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices.

    Science.gov (United States)

    Topkara, Veli K; Coromilas, Ellie J; Garan, Arthur Reshad; Li, Randall C; Castagna, Francesco; Jennings, Douglas L; Yuzefpolskaya, Melana; Takeda, Koji; Takayama, Hiroo; Sladen, Robert N; Mancini, Donna M; Naka, Yoshifumi; Radhakrishnan, Jai; Colombo, Paolo C

    2016-12-01

    Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015. Baseline demographics, comorbid conditions, clinical risk scores, and renal function were analyzed in patients with or without RRT after CF-LVAD implantation. Time-dependent receiver-operating characteristic curve analysis was performed to define optimal cutoffs for continuous risk factors. Forty-four patients (11.6%) required RRT during a median follow-up of 9.9 months. Patients requiring RRT had significantly worse renal function, lower hemoglobin, and increased proteinuria at baseline. Low estimated glomerular filtration rate (proteinuria (urine protein to creatinine ratio ≥0.55 mg/mg) were significant predictors of RRT after CF-LVAD support. Dipstick proteinuria was also a significant predictor of RRT after CF-LVAD implantation. Patients with both low estimated glomerular filtration rate and proteinuria had highest risk of RRT (63.6%) compared with those with either low estimated glomerular filtration rate or proteinuria (18.7%) and those with neither of these risk factors (2.7%) at 1-year follow-up (log-rank Pproteinuria are predictors RRT after CF-LVAD implantation and should be routinely assessed in CF-LVAD candidates to guide decision making. © 2016 American Heart Association, Inc.

  5. 1-alpha-Hydroxyvitamin D3 derivatives in the treatment of renal bone diseases: justification and optimal modalities of administration.

    Science.gov (United States)

    Fournier, A; Morinière, P H; Oprisiu, R; Yverneau-Hardy, P; Westeel, P F; Mazouz, H; el Esper, N; Ghazali, A; Boudailliez, B

    1995-01-01

    combination with oral calcium over 1 alpha(OH)D3 derivatives in the treatment of uremic hyperparathyroidism are still waiting for clinical demonstration. Vitamin D derivatives have no place in the treatment of aluminic bone diseases which necessitate long term deferoxamine treatment and prevention of aluminum exposure by the dialysate and the phosphate binders. They are not indicated in the treatment of 'idiopathic' adynamic bone disease which is due to uremia per se combined with an excessive PTH suppression for the degree of renal failure. This low bone turnover pattern is associated with an increased risk of hypercalcemia and hyperphosphatemia and necessitates only a stimulation of PTH secretion by inducing a negative calcium balance with a lower dialysate calcium concentration or simply by discontinuing the oral calcium supplement in the uremic patient not yet dialyzed. In rare cases this pattern is due to a granulomatosis and is corrected by prednisone.

  6. Renal angiomyolipoma bleeding in a patient with TSC2/PKD1 contiguous gene syndrome after 17 years of renal replacement therapy.

    Science.gov (United States)

    Furlano, Mónica; Barreiro, Yaima; Martí, Teresa; Facundo, Carme; Ruiz-García, César; DaSilva, Iara; Ayasreh, Nadia; Cabrera-López, Cristina; Ballarín, José; Ars, Elisabet; Torra, Roser

    We report the case of a 32-year-old male diagnosed with TSC2/PKD1 contiguous gene syndrome, presenting with tuberous sclerosis (TS) and autosomal dominant polycystic kidney disease simultaneously. He progressed to end-stage renal disease and received a kidney transplant at the age of 12. The native kidneys presented angiomyolipomas (AML), which are common benign tumours in patients with TS. Seventeen years after transplantation, he presented with abdominal pain, anaemia and a retroperitoneal haematoma, the latter caused by renal AML bleeding. Selective embolisation was performed. Our patient could have benefited from the administration of mTOR inhibitors at transplant. This therapy is immunosuppressive and reduces the size of benign tumours in TS as well as the risk of rupture and bleeding. This patient did not receive mTOR inhibitors at the time of the transplant because the relationship between mTOR inhibitors and TS was unknown at that time. This case confirms the persistent risk of renal AML bleeding for both transplanted patients and patients on dialysis. As a result, we would recommend routine check-ups of native kidneys and nephrectomy assessment.

  7. Renal angiomyolipoma bleeding in a patient with TSC2/PKD1 contiguous gene syndrome after 17 years of renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Mónica Furlano

    2017-01-01

    Full Text Available We report the case of a 32-year-old male diagnosed with TSC2/PKD1 contiguous gene syndrome, presenting with tuberous sclerosis complex (TSC and autosomal dominant polycystic kidney disease simultaneously. He progressed to end-stage renal disease and received a kidney transplant at the age of 12. The native kidneys presented angiomyolipomas (AML, which are common benign tumours in patients with TSC. Seventeen years after transplantation, he presented with abdominal pain, anaemia and a retroperitoneal haematoma, the latter caused by renal AML bleeding. Selective embolisation was performed. Our patient could have benefited from the administration of mTOR inhibitors at transplant. This therapy is immunosuppressive and reduces the size of benign tumours in TSC as well as the risk of rupture and bleeding. This patient did not receive mTOR inhibitors at the time of the transplant because the relationship between mTOR inhibitors and TSC was unknown at that time. This case confirms the persistent risk of renal AML bleeding for both transplanted patients and patients on dialysis. As a result, we would recommend routine check-ups of native kidneys and nephrectomy assessment.

  8. A systematic review of antibiotic dosing regimens for septic patients receiving continuous renal replacement therapy: do current studies supply sufficient data?

    Science.gov (United States)

    Li, A M M Y; Gomersall, C D; Choi, G; Tian, Q; Joynt, G M; Lipman, J

    2009-11-01

    Drug dosing for septic patients with acute renal failure receiving continuous renal replacement therapy (CRRT) is complicated, and failure to correctly dose may result in either drug toxicity or treatment failure and development of antibiotic resistance. The aim of this study was to establish an ideal dataset that needs to be reported when presenting pharmacokinetic data for these patients and review current literature for completeness of this dataset. An ideal dataset was established of the parameters that should be reported when calculating a drug dosing regimen from first principles. A Medline search was performed of relevant literature producing 64 citations from which completeness of the specified criteria was examined. None of the studies analysed presented the full dataset that we established as necessary. Of concern, basic pharmacokinetic parameters such as volume of distribution (V(d)) and clearance (CL) were specified in only 79% and 81% of studies, respectively. A large proportion of current studies do not report key information necessary to devise a rational dosing regimen for patients with acute renal failure receiving CRRT, and we hope this dataset will be a useful guide when reporting future pharmacokinetic data.

  9. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  10. Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus

    Science.gov (United States)

    Kramer, Anneke; Pippias, Maria; Stel, Vianda S.; Bonthuis, Marjolein; Abad Diez, José Maria; Afentakis, Nikolaos; Alonso de la Torre, Ramón; Ambuhl, Patrice; Bikbov, Boris; Bouzas Caamaño, Encarnación; Bubic, Ivan; Buturovic-Ponikvar, Jadranka; Caskey, Fergus J.; Castro de la Nuez, Pablo; Cernevskis, Harijs; Collart, Frederic; Comas Farnés, Jordi; Garcia Bazaga, Maria de los Ángeles; De Meester, Johan; Ferrer Alamar, Manuel; Finne, Patrik; Garneata, Liliana; Golan, Eliezer; G. Heaf, James; Hemmelder, Marc; Ioannou, Kyriakos; Kantaria, Nino; Kolesnyk, Mykola; Kramar, Reinhard; Lassalle, Mathilde; Lezaic, Visnja; Lopot, Frantisek; Macário, Fernando; Magaz, Angela; Martín-Escobar, Eduardo; Metcalfe, Wendy; Ots-Rosenberg, Mai; Palsson, Runolfur; Piñera Celestino, Celestino; Resić, Halima; Rutkowski, Boleslaw; Santiuste de Pablos, Carmen; Spustová, Viera; Stendahl, Maria; Strakosha, Ariana; Süleymanlar, Gültekin; Torres Guinea, Marta; Varberg Reisæter, Anna; Vazelov, Evgueniy; Ziginskiene, Edita; Massy, Ziad A.; Wanner, Christoph; Jager, Kitty J.; Noordzij, Marlies

    2016-01-01

    Background This article provides a summary of the 2013 European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at http://www.era-edta-reg.org), with a focus on patients with diabetes mellitus (DM) as the cause of end-stage renal disease (ESRD). Methods In 2015, the ERA-EDTA Registry received data on renal replacement therapy (RRT) for ESRD from 49 national or regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea. Individual patient data were provided by 31 registries, while 18 registries provided aggregated data. The total population covered by the participating registries comprised 650 million people. Results In total, 72 933 patients started RRT for ESRD within the countries and regions reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 per million population (pmp). The overall prevalence on 31 December 2013 was 738 pmp (n = 478 990). Patients with DM as the cause of ESRD comprised 24% of the incident RRT patients (26 pmp) and 17% of the prevalent RRT patients (122 pmp). When compared with the USA, the incidence of patients starting RRT pmp secondary to DM in Europe was five times lower and the incidence of RRT due to other causes of ESRD was two times lower. Overall, 19 426 kidney transplants were performed (30 pmp). The 5-year adjusted survival for all RRT patients was 60.9% [95% confidence interval (CI) 60.5–61.3] and 50.6% (95% CI 49.9–51.2) for patients with DM as the cause of ESRD. PMID:27274834

  11. What Modals Are: Modal Verbs, Modal Words, and Auxiliary Modals

    Directory of Open Access Journals (Sweden)

    Fazira A. Kakzhanova

    2013-01-01

    Full Text Available The modals are a complicated grammatical phenomenon. As of today, the status of modals is still not precisely defined in the linguistics literature, and they are described under different names: modal verbs, modal words, auxiliary modals, or defective verbs. Modals express the result of the conversion of thought processes (deep structure about the realization of actions into surface structure. As articles determine the status of nouns as indefinite or definite things, modals determine the relation of a person to actions or the quality of an action as realizable or unrealizable. Modals cannot truly be ‘modal verbs’, because they lack the morphological characteristics of verbs (aspect, voice, mood, and tense, and the term ‘defective verb’ is flawed for the same reason. Furthermore, they cannot be ‘auxiliary modals’, because they don’t neutralize their main meanings when they become auxiliary. Thus, I propose to refer to these elements only as modals or modal words.

  12. Renal dysplasia and MRI: a clinician's perspective

    Energy Technology Data Exchange (ETDEWEB)

    Greenbaum, Larry A. [Emory University, Division of Pediatric Nephrology, Children' s Healthcare of Atlanta, Atlanta, GA (United States)

    2008-01-15

    Renal dysplasia is a common abnormality in children. The role of MRI in evaluating children with renal dysplasia is evolving. More information is clearly necessary before MRI replaces conventional imaging modalities. In order to appropriately use MRI, the radiologist must have an understanding of the clinical questions that are important in the management of children with renal dysplasia. This review provides background information on renal dysplasia for the pediatric radiologist. The focus is on unilateral disease, especially multicystic dysplastic kidneys, and bilateral dysplasia, which is the most common cause of kidney failure in children. The emphasis is on the important clinical issues, and the potential of MRI as a methodology for providing clinically useful information not otherwise available from other imaging modalities. (orig.)

  13. Abdominal plain film in patients admitted with clinical suspicion of renal colic: should it be replaced by low-dose computed tomography?

    Science.gov (United States)

    Poletti, Pierre-Alexandre; Platon, Alexandra; Rutschmann, Olivier T; Verdun, Francis R; Schmidlin, Franz R; Iselin, Christophe E; Vermeulen, Bernard; Sarasin, François P; Buhler, Léo H; Becker, Christoph D

    2006-01-01

    To evaluate a low-dose abdominal computed tomography (LDCT) protocol, delivering a radiation dose close to that delivered by an abdominal plain film (APF), in patients with a clinical suspicion of renal colic. A total of 139 patients for whom an APF was requested for suspicion of renal colic were randomized into two groups. The patients in group 1 (n = 68) underwent an admission LDCT scan delivering a 2.1-mSv radiation dose to women and 1.6 mSv to men, instead of the APF. Patients in group 2 (n = 71) underwent an APF. Clinical and radiologic follow-up data were obtained for each patient. The number of additional abdominal ultrasound and CT scans performed to reach a confident final diagnosis and determine the proper treatment was compared between the two groups. A mean effective radiation dose was obtained in each group. Of the 68 patients in group 1 (LDCT), 10 (15%) underwent ultrasonography, 9 (13%) conventional abdominal CT, and 2 (3%) both. In group 2 (APF), the corresponding percentages were 27% (19 of 71), 28% (20 of 71), and 23% (16 of 71). Of the 68 patients in group 1, 47 (69%) did not require any additional examinations compared with 16 (23%) of the 71 patients in group 2 (P < 0.0001). The mean effective dose was 3.5 and 6.9 mSv in groups 1 and 2, respectively (P < 0.0001). In patients with suspicion of renal colic, replacing the admission APF with our LDCT protocol will significantly reduce the need for additional CT or ultrasonography. Also, our LDCT protocol decreases by almost 50% the mean radiation dose per patient.

  14. Lifetime risk of renal replacement therapy in Europe: a population-based study using data from the ERA-EDTA Registry.

    Science.gov (United States)

    van den Brand, Jan A J G; Pippias, Maria; Stel, Vianda S; Caskey, Fergus J; Collart, Frederic; Finne, Partik; Heaf, James; Jais, Jean-Philippe; Kramar, Reinhard; Massy, Ziad A; De Meester, Johan; Traynor, Jamie P; Reisæter, Anna Varberg; Wetzels, Jack F M; Jager, Kitty J

    2017-02-01

    Upcoming KDIGO guidelines for the evaluation of living kidney donors are expected to move towards a personal risk-based evaluation of potential donors. We present the age and sex-specific lifetime risk of renal replacement therapy (RRT) for end-stage renal disease in 10 European countries. We defined lifetime risk of RRT as the cumulative incidence of RRT up to age 90 years. We obtained RRT incidence rates per million population by 5-year age groups and sex using data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, and used these to estimate the cumulative incidence of RRT, adjusting for competing mortality risk. Lifetime risk of RRT varied from 0.44% to 2.05% at age 20 years and from 0.17% to 1.59% at age 70 years across countries, and was twice as high in men as in women. Lifetime RRT risk decreased with age, ranging from an average of 0.77% to 0.44% in 20- to- 70-year-old women, and from 1.45% to 0.96% in 20- to- 70-year-old men. The lifetime risk of RRT increased slightly over the past decade, more so in men than in women. However, it appears to have stabilized or even decreased slightly in more recent years. The lifetime risk of RRT decreased with age, was lower in women as compared with men of equal age and varied considerably throughout Europe. Given the substantial differences in lifetime risk of RRT between the USA and Europe, country-specific estimates should be used in the evaluation and communication of the risk of RRT for potential living kidney donors.

  15. Changing modalities

    NARCIS (Netherlands)

    Renardel de Lavalette, Gerard R.

    2004-01-01

    The dynamic modal logic DML is presented, featuring actions that change the interpretation of a propositional variable or a modality. The semantics is defined both in terms of modal structures and of labelled transition systems (Kripke models). The extension µDML with recursively defined actions aim

  16. Analysis of data from the ERA-EDTA Registry indicates that conventional treatments for chronic kidney disease do not reduce the need for renal replacement therapy in autosomal dominant polycystic kidney disease.

    NARCIS (Netherlands)

    Spithoven, E.M.; Kramer, A.; Meijer, E.; Orskov, B.; Wanner, C.; Caskey, F.; Collart, F.; Finne, P.; Fogarty, D.G.; Groothoff, J.W.; Hoitsma, A.J.; Nogier, M.B.; Postorino, M.; Ravani, P.; Zurriaga, O.; Jager, K.J.; Gansevoort, R.T.; Bindels, R.J.M.

    2014-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney failure, but is often identified early and therefore amenable to timely treatment. Interventions known to postpone the need for renal replacement therapy (RRT) in non-ADPKD patients have also been tested in ADP

  17. Analysis of data from the ERA-EDTA Registry indicates that conventional treatments for chronic kidney disease do not reduce the need for renal replacement therapy in autosomal dominant polycystic kidney disease

    NARCIS (Netherlands)

    Spithoven, Edwin M.; Kramer, Anneke; Meijer, Esther; Orskov, Bjarne; Wanner, Christoph; Caskey, Fergus; Collart, Frederic; Finne, Patrik; Fogarty, Damian G.; Groothoff, Jaap W.; Hoitsma, Andries; Nogier, Marie-Beatrice; Postorino, Maurizio; Ravani, Pietro; Zurriaga, Oscar; Jager, Kitty J.; Gansevoort, Ron T.

    2014-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney failure, but is often identified early and therefore amenable to timely treatment. Interventions known to postpone the need for renal replacement therapy (RRT) in non-ADPKD patients have also been tested in ADP

  18. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  19. Continuous renal replacement therapy (CRRT) attenuates myocardial inflammation and mitochondrial injury induced by venovenous extracorporeal membrane oxygenation (VV ECMO) in a healthy piglet model.

    Science.gov (United States)

    Shen, Juanhong; Yu, Wenkui; Chen, Qiyi; Shi, Jialiang; Hu, Yimin; Zhang, Juanjuan; Gao, Tao; Xi, Fengchan; He, Changsheng; Gong, Jianfeng; Li, Ning; Li, Jieshou

    2013-10-01

    In this study, we investigated the myocardial inflammation and mitochondrial function during venovenous extracorporeal membrane oxygenation (VV ECMO) and further evaluated the effects of continuous renal replacement therapy (CRRT) on them. Eighteen piglets were assigned to the control group, ECMO group, and ECMO+CRRT group. Myocardial inflammation was assessed by the activity of myeloperoxidase (MPO), myocardial concentrations, and mRNA expression of TNF-α, IL-1β, and IL-6; mitochondrial function was assessed by activities of mitochondrial complexes I-V. VV ECMO elicited a general activation of serum and myocardial inflammation and significantly decreased the activities of mitochondrial complexes I and IV. After being combined with CRRT, serum and myocardial concentrations of IL-1β and IL-6, myocardial mRNA expression of IL-6, and the activity of MPO were decreased significantly; the activities of mitochondrial complexes were increased. We conclude that myocardial inflammation was activated during ECMO therapy, inducing mitochondrial injury; moreover, CRRT reduced myocardial inflammation and partially ameliorated mitochondrial function.

  20. Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.

    Science.gov (United States)

    Sanchez-Izquierdo-Riera, Jose Angel; Molano-Alvarez, Esteban; Saez-de la Fuente, Ignacio; Maynar-Moliner, Javier; Marín-Mateos, Helena; Chacón-Alves, Silvia

    2016-01-01

    The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.

  1. Selecting renal replacement therapies: what do African American and non-African American patients and their families think others should know? A mixed methods study

    Directory of Open Access Journals (Sweden)

    DePasquale Nicole

    2013-01-01

    Full Text Available Abstract Background Little is known regarding the types of information African American and non-African American patients with chronic kidney disease (CKD and their families need to inform renal replacement therapy (RRT decisions. Methods In 20 structured group interviews, we elicited views of African American and non-African American patients with CKD and their families about factors that should be addressed in educational materials informing patients’ RRT selection decisions. We asked participants to select factors from a list and obtained their open-ended feedback. Results Ten groups of patients (5 African American, 5 non-African American; total 68 individuals and ten groups of family members (5 African American, 5 non-African American; total 62 individuals participated. Patients and families had a range (none to extensive of experiences with various RRTs. Patients identified morbidity or mortality, autonomy, treatment delivery, and symptoms as important factors to address. Family members identified similar factors but also cited the effects of RRT decisions on patients’ psychological well-being and finances. Views of African American and non-African American participants were largely similar. Conclusions Educational resources addressing the influence of RRT selection on patients’ morbidity and mortality, autonomy, treatment delivery, and symptoms could help patients and their families select RRT options closely aligned with their values. Including information about the influence of RRT selection on patients’ personal relationships and finances could enhance resources’ cultural relevance for African Americans.

  2. Tuberculin skin test for the diagnosis of latent tuberculosis during renal replacement therapy in an endemic area: A single center study.

    Science.gov (United States)

    Agarwal, S K; Gupta, S; Bhowmik, D; Mahajan, S

    2010-07-01

    Patients on renal replacement therapy (RRT) are at-risk for developing tuberculosis (TB). There is limited information on tuberculin skin test (TST) and its predictability for development of TB. In this prospective cohort study, patients taken for RRT were included. Patients with active TB were excluded. TST was done with 5-tuberculin unit. In addition to TST, age, sex, diabetes as basic disease, number of dialysis and blood transfusion (BT), pre-transplant TB, hepatitis B and C infections and type of immunosuppression were correlated with the development of TB. Of the 200 patients included, TST was positive in 21 and negative in 179. In TST negative group, 20 (11.1%) and in TST positive group 5 (23.8%) patients developed TB. TB free survival in two groups was similar (P = 0.08). On multivariate Cox regression analysis, hazard of development of TB by TST was 2.7 [P = 0.11, confidence interval (CI) 0.78-9.7]. There was no difference between TST non-responsive and TST negative patients (P = 0.18). Sensitivity and specificity of TST for predicting TB was only 20 and 9%, respectively. Our study shows that TST in patients on dialysis is an insensitive and nonspecific test to predict development of active TB.

  3. Defeasible modalities

    CSIR Research Space (South Africa)

    Britz, K

    2013-01-01

    Full Text Available with a preference ordering on worlds in Kripke models. The resulting family of modal logics allow for the elegant expression of defeasible modalities. We also propose a tableau calculus which is sound and complete with respect to our preferential...

  4. Effects of initiating chronic renal replacement therapy in children, now and later in life: Data from the LERIC cohort and ERA-EDTA Registry

    NARCIS (Netherlands)

    J.L. Vogelzang

    2015-01-01

    This thesis describes the most important results of LERIC (Late Effects of Renal Insufficiency in Children), a very a long-term follow-up study to the late somatic and psychosocial consequences of renal insufficiency in children. LERIC is a comprehensive study to evaluate the late effects of renal i

  5. 肾移植围手术期补液监控%Fluid replacement monitoring during perioperative period of renal transplantation

    Institute of Scientific and Technical Information of China (English)

    张更; 袁建林; 王禾; 孟俊华; 武国军; 秦卫军; 于磊; 李欣; 张运涛; 刘贺亮

    2008-01-01

    renal transplantation.DESIGN, TIME AND SETTING: A retrospective clinical analysis was performed in the Department of Urology, Xijing Hospital from June 2003 to June 2007.PARTICIPANTS: Ninety-six patients of chronic renal failure underwent allograft renal transplantation. They comprised 59 males and 37 females, aged 17-67 years, with a mean of 35.7 years.METHODS: The perioperative physiological features of the renal transplantation recipients were summarized retrospectively. The recipients' condition during the perioperative period was divided into two stages at the opening point of allograft blood current. The vital signs of the patients maintained at a stable level before operation. All patients received blood transfusion since the operation began, and were supplemented with albumin before opening the vessels. Urinary production exceeding 100 mL per hour indicated the beginning of fluid replacement, which was a simplified transfusion for the patients at diuresis stage following renal transplantation.MAIN OUTCOME MEASURES: Blood inosine, urea nitrogen, electrolyte, blood sugar and urine of the patients were detected at one day postoperatively.RESULTS: During 12-16 hours postoperatively, the urinary production was 260-1 200 mL, average 520 mL per hour. Blood routine test showed 8 cases developed mild hyponatremia, accounting for 8.3%, 3 cases occurred high potassium and healed after renal functional recovery, 1 case presented low potassium and healed with supplement therapy. There were no abnormal changes of blood chlorine. The blood glucose among 21 cases (21.9%) was higher than the normal level, and recovered following hormone maneuver. The electrolytes and blood glucose were detected to be normal in other patients, without any case with low calcium or magnesium. The urine specific gravity arranged during 1.010-1.015.CONCLUSION: The colloid such as erythrocytes, blood plasma and albumin should be mainly infused before the opening of allograft blood current. And the

  6. Acute renal failure in the intensive care unit.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2006-06-01

    Acute renal failure (ARF) is a common complication in critically ill patients, with ARF requiring renal replacement therapy (RRT) developing in approximately 5 to 10% of intensive care unit (ICU) patients. Epidemiological studies have demonstrated that ARF is an independent risk factor for mortality. Interventions to prevent the development of ARF are currently limited to a small number of settings, primarily radiocontrast nephropathy and rhabdomyolysis. There are no effective pharmacological agents for the treatment of established ARF. Renal replacement therapy remains the primary treatment for patients with severe ARF; however, the data guiding selection of modality of RRT and the optimal timing of initiation and dose of therapy are inconclusive. This review focuses on the epidemiology and diagnostic approach to ARF in the ICU and summarizes our current understanding of therapeutic approaches including RRT.

  7. Dialysis complications in acute kidney injury patients treated with prolonged intermittent renal replacement therapy sessions lasting 10 versus 6 hours: results of a randomized clinical trial.

    Science.gov (United States)

    Albino, Bianca Ballarin; Balbi, André Luis; Abrão, Juliana Maria Gera; Ponce, Daniela

    2015-05-01

    Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed. Seventy-five patients were treated with 195 PIRRT sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalemia, and hypophosphatemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 was composed of 38 patients treated with 100 sessions, whereas G2 consisted of 37 patients treated with 95 sessions. G1 and G2 were similar in male predominance (65.7 vs. 75.6%, P = 0.34), age (63.6 ± 14 vs. 59.9 ± 15.5 years, P = 0.28) and Sequential Organ Failure Assessment score (SOFA; 13.1 ± 2.4 vs. 14.2 ± 3.0, P = 0.2). There was no significant difference between the two groups in hypotension (81.5 vs. 83.7%, P = 0.8), filter clotting (23.6 vs. 27%, P = 0.73), hypokalemia (13.1 vs. 8.1%, P = 0.71), and hypophosphatemia (18.4 vs. 21.6%, P = 0.72). However, the group treated with sessions of 10 h were refractory to clinical measures for hypotension, and dialysis sessions were interrupted more often (9.5 vs. 30.1%, P = 0.03). Metabolic control and fluid balance were similar between G1 and G2 (blood urea nitrogen [BUN]: 81 ± 30 vs. 73 ± 33 mg/dL, P = 1.0; delivered Kt/V: 1.09 ± 0.24 vs. 1.26 ± 0.26, P = 0.09; actual ultrafiltration: 1731 ± 818 vs. 2332 ± 947 mL, P = 0.13) and fluid balance (-731 ± 125 vs. -652 ± 141

  8. Postoperative Fluid Overload is a Useful Predictor of the Short-Term Outcome of Renal Replacement Therapy for Acute Kidney Injury After Cardiac Surgery.

    Science.gov (United States)

    Xu, Jiarui; Shen, Bo; Fang, Yi; Liu, Zhonghua; Zou, Jianzhou; Liu, Lan; Wang, Chunsheng; Ding, Xiaoqiang; Teng, Jie

    2015-08-01

    To analyze the predictive value of postoperative percent fluid overload (PFO) of renal replacement therapy (RRT) for acute kidney injury (AKI) patients after cardiac surgery.Data from 280 cardiac surgery patients between 2005 January and 2012 April were collected for retrospective analyses. A receiver operating characteristic (ROC) curve was used to compare the predictive values of cumulative PFO at different times after surgery for 90-day mortality.The cumulative PFO before RRT initiation was 7.9% ± 7.1% and the median PFO 6.1%. The cumulative PFO before and after RRT initiation in intensive care unit (ICU) was higher in the death group than in the survival group (8.8% ± 7.6% vs 6.1% ± 5.6%, P = 0.001; -0.5[-5.6, 5.1]% vs 6.9[2.2, 14.6]%, P 731, and 0.752. PFO during the whole ICU stay ≥7.2% was determined as the cut-off point for 90-day mortality prediction with a sensitivity of 77% and a specificity of 64%. Kaplan-Meier survival estimates showed a significant difference in survival among patients with cumulative PFO ≥ 7.2% and PFO < 7.2% after cardiac surgery (log-rank P < 0.001).Postoperative cumulative PFO during the whole ICU stay ≥7.2% would have an adverse effect on 90-day short-term outcome, which may provide a strategy for the volume control of AKI-RRT patients after cardiac surgery.

  9. Peramivir pharmacokinetics in two critically ill adults with 2009 H1N1 influenza A concurrently receiving continuous renal replacement therapy.

    Science.gov (United States)

    Bazan, Jose A; Bauer, Karri A; Hollister, Alan S; Shidham, Ganesh; Firstenberg, Michael S; Reed, Erica E; Mangino, Julie E; Goff, Debra A

    2010-10-01

    To determine the pharmacokinetics of intravenous peramivir-an investigational neuraminidase inhibitor for the treatment of 2009 H1N1 infection or nonsubtypable influenza A thought to be the 2009 H1N1 virus-in patients concurrently receiving continuous renal replacement therapy (CRRT). Pharmacokinetic analysis. Critical care unit at a university-affiliated hospital. Two critically ill women with 2009 H1N1 influenza A treated with compassionate-use intravenous peramivir administered as a daily infusion of 600 mg over 30 minutes while receiving continuous venovenous hemodiafiltration (CVVHDF), a form of CRRT. Plasma samples were collected from the two patients before and 30 minutes after the fourth (first patient) and ninth (second patient) peramivir infusion to estimate minimum (C(min)) and maximum (C(max)) plasma concentrations, respectively. Two additional postinfusion concentrations were measured from each patient to estimate noncompartmental pharmacokinetic parameters of peramivir while receiving CVVHDF. In the two patients, respectively, C(min) was 2170 and 251 ng/ml, C(max) was 18,400 and 20,300 ng/ml, area under the plasma concentration-time curve from 0-24 hours (AUC(0-24)) was 178,000 and 94,400 ng·hour/ml, drug clearance was 56 and 106 ml/minutes, and plasma half-life was 7.6 and 3.7 hours. The volume of distribution adjusted for ideal body weight at steady state was 0.51 and 0.54 L/kg, respectively. The first patient had a slower peramivir plasma clearance compared with the second patient, but both patients had higher peramivir clearances as calculated from AUC(0-24) than those predicted by CRRT. Thus, the dosage of intravenous peramivir was appropriate in these patients. Additional pharmacokinetic data are needed to confirm these results and help guide dosing in patients receiving various forms of CRRT.

  10. Impact of β-lactam antibiotic therapeutic drug monitoring on dose adjustments in critically ill patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Economou, Caleb J P; Wong, Gloria; McWhinney, Brett; Ungerer, Jacobus P J; Lipman, Jeffrey; Roberts, Jason A

    2017-05-01

    The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10× the minimum inhibitory concentration (MIC). A total of 111 TDM samples from 76 patients (46 male) with a mean ± standard deviation age of 56.6 ± 15.9 years and weight of 89.1 ± 25.8 kg were identified. The duration of antibiotic therapy was between 2 days and 42 days. TDM identified a need for dose modification of β-lactam antibiotics in 39 (35%) instances; in 27 (24%) samples, TDM values resulted in decreasing the prescribed dose of β-lactam antibiotic whereas an increase in the prescribed dose occurred in 12 (11%) cases. In patients treated for hospital-acquired pneumonia and primary or secondary bacteraemia, the dose was required to be decreased in 10/25 (40%) and 7/46 (15%) cases, respectively, to attain target concentrations. β-Lactam TDM is a useful tool for guiding drug dosing in complex patients such as those receiving CRRT. Although over one-third of patients manifested concentrations outside the therapeutic range, most of these CRRT patients had excessive β-lactam concentrations. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  11. Technology insight: Innovative options for end-stage renal disease--from kidney refurbishment to artificial kidney.

    Science.gov (United States)

    Braam, Branko; Verhaar, Marianne C; Blankestijn, Peter; Boer, Walther H; Joles, Jaap A

    2007-10-01

    The steadily growing number of patients with chronic kidney disease who will eventually develop end-stage renal disease, together with the qualitative limitations of currently available renal replacement therapies, have triggered the exploration of innovative strategies for renal replacement therapy and for salvage of renal function. Currently, new hemodialysis modalities and membranes are being used with the aim of increasing clearance of uremic toxins to afford better metabolic control. In addition to these conventional approaches, there are four innovative potential solutions to the problem of replacing renal function when kidneys fail. The first is a small, implantable device with the potential to be supplemented with human cells ('artificial kidney'). The second involves restoration of the damaged kidney by harnessing recent advances in stem-cell technology and knowledge of developmental programing ('refurbished kidney'). The third is (partially) growing a kidney in vitro with the use of therapeutic cloning ('cultured kidney'). The fourth innovative solution involves the use of other organs to replace various renal functions ('distributed kidney'). In this article we review the efforts that have been made to improve renal replacement therapies, and explore innovative approaches. We will not cover all potential solutions in detail. Rather, we aim to indicate directions of future endeavor and arouse enthusiasm in clinicians and scientists for exploration of these exciting avenues.

  12. Analysis on Modals and Semi-Modals

    Institute of Scientific and Technical Information of China (English)

    陈力

    2014-01-01

    The modal is a type of auxiliary verb that is used to indicate modality. There are thirteen modal auxiliaries including some past tense forms. In this paper, the modals and semi-modals will be studied through analyzing fifteen sample sentences and referring some grammar books. At last, some suggestions for ESL or ESL teacher to teach modals will be provided.

  13. Predictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renal replacement therapy

    Institute of Scientific and Technical Information of China (English)

    LI Wen-xiong; CHEN Hui-de; WANG Xiao-wen; ZHAO Song; CHEN Xiu-kai; ZHENG Yue; SONG Yang

    2009-01-01

    Background The optimal timing to start continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) patients has not been accurately established. The recently proposed risk, injury, failure, loss, end-stage kidney disease (RIFLE) criteria for diagnosis and classification of AKI may provide a method for clinicians to decide the "optimal timing" for starting CRRT under uniform guidelines. The present study aimed: (1) to analyze the correlation between RIFLE stage at the start of CRRT and 90-day survival rate after CRRT start, (2) to further investigate the correlation of RIFLE stage with the malignant kidney outcome in the 90-day survivors, and (3) to determine the influence of the timing of CRRT defined by RIFLE classification on the 90-day survival and malignant kidney outcome in 90-day survivors. Methods A retrospective cohort analysis was performed on the data of 106 critically ill patients with AKI, treated with CRRT during a 6-year period in a university affiliated surgical intensive care unit (SICU). Information such as sex, age, RIFLE stage, sepsis, sepsis-related organ failure assessment (SOFA) score, number of organ failures before CRRT, CRRT time during SiCU, survival, and kidney outcome conditions at 90 days after CRRT start was collected. According to their baseline severity of AKI at the start of CRRT, the patients were assigned to three groups according to the increasing severity of RIFLE stages: RIFLE-R (risk of renal dysfunction, R), RIFLE-I (injury to the kidney, I) and RIFLE-F (failure of kidney function, F) using RIFLE criteria. The malignant kidney outcome was classified as RIFLE-L (loss of kidney function, L) or RIFLE-E (end-stage kidney disease, E) using RIFLE criteria. The correlation between RIFLE stage and 90-day survival rate was analyzed among these three RIFLE-categorized groups. Additionally, the association between RIFLE stage and the malignant kidney outcome (RIFLE-L+RIFLF-E) in the 90-day survivors was analyzed

  14. Meropenem population pharmacokinetics in critically ill patients with septic shock and continuous renal replacement therapy: influence of residual diuresis on dose requirements.

    Science.gov (United States)

    Ulldemolins, Marta; Soy, Dolors; Llaurado-Serra, Mireia; Vaquer, Sergi; Castro, Pedro; Rodríguez, Alejandro H; Pontes, Caridad; Calvo, Gonzalo; Torres, Antoni; Martín-Loeches, Ignacio

    2015-09-01

    Meropenem dosing in critically ill patients with septic shock and continuous renal replacement therapy (CRRT) is complex, with the recommended maintenance doses being 500 mg to 1,000 mg every 8 h (q8h) to every 12 h. This multicenter study aimed to describe the pharmacokinetics (PKs) of meropenem in this population to identify the sources of PK variability and to evaluate different dosing regimens to develop recommendations based on clinical parameters. Thirty patients with septic shock and CRRT receiving meropenem were enrolled (153 plasma samples were tested). A population PK model was developed with data from 24 patients and subsequently validated with data from 6 patients using NONMEM software (v.7.3). The final model was characterized by CL = 3.68 + 0.22 · (residual diuresis/100) and V = 33.00 · (weight/73)(2.07), where CL is total body clearance (in liters per hour), residual diuresis is the volume of residual diuresis (in milliliters per 24 h), and V is the apparent volume of distribution (in liters). CRRT intensity was not identified to be a CL modifier. Monte Carlo simulations showed that to maintain concentrations of the unbound fraction (fu ) of drug above the MIC of the bacteria for 40% of dosing interval T (referred to as 40% of the ƒ uT >MIC), a meropenem dose of 500 mg q8h as a bolus over 30 min would be sufficient regardless of the residual diuresis. If 100% of the ƒ uT >MIC was chosen as the target, oligoanuric patients would require 500 mg q8h as a bolus over 30 min for the treatment of susceptible bacteria (MIC dose given as an infusion over 3 h. If bacteria with MICs close to the resistance breakpoint (2 to 4 mg/liter) were to be treated with meropenem, a dose of 500 mg every 6 h would be necessary: a bolus over 30 min for oligoanuric patients and an infusion over 3 h for patients with preserved diuresis. Our results suggest that residual diuresis may be an easy and inexpensive tool to help with titration of the meropenem dose and infusion

  15. Cefepime and continuous renal replacement therapy (CRRT): in vitro permeability of two CRRT membranes and pharmacokinetics in four critically ill patients.

    Science.gov (United States)

    Isla, Arantxazu; Gascón, Alicia Rodríguez; Maynar, Javier; Arzuaga, Alazne; Toral, Darío; Pedraz, José Luis

    2005-05-01

    Cefepime is a fourth-generation cephalosporin with a broad spectrum of antimicrobial activity against gram-positive and gram-negative micro-organisms. It is a useful option for treating infections in critically ill patients in intensive care due to its high degree of activity and its tolerability. The aim of this study was to characterize in vitro the permeability to cefepime of 2 membranes frequently used in continuous renal replacement therapies (CRRTs). An in vivo study was also carried out to determine the pharmacokinetics of cefepime in critically ill patients undergoing CRRT. In vitro procedures were conducted in 3 different fluids using polyacrylonitrile (AN69) or polysulfone (PS) membranes. Continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) were simulated. Four male patients undergoing CVVH or continuous venovenous hemodiafiltration, who received 2000 mg of cefepime intravenously every 8 hours, entered the in vivo study. Prefilter and ultrafiltrate samples were collected, and concentrations of cefepime were measured using high-performance liquid chromatography. The sieving coefficient (Sc), defined as the fraction of drug eliminated across the membrane, and the saturation coefficient (Sa), defined as the fraction of drug diffused through the membrane to the dialysate fluid, were analyzed. Pharmacokinetic parameters were determined according to a noncompartmental analysis. The patients ranged in age from 18 to 75 years and weighed from 65 to 80 kg. By analyzing Sc and Sa values in the in vitro procedures, no differences were detected in the permeability of AN69 or PS membranes to cefepime in CVVH or CVVHD. Sc/Sa values were between 0.93 and 1.03 in Ringer's lactate and in bovine albumin-containing Ringer's lactate samples, but Sc/Sa values were lower in plasma samples (0.82-0.95). In the in vivo portion of the study, the patients' mean (SD) Sc/Sa value was 0.76 (0.21) and correlated well with the fraction unbound to

  16. Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal replacement therapy for acute renal failure (VERROU-REA study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bruyère, Rémi; Soudry-Faure, Agnès; Capellier, Gilles; Binquet, Christine; Nadji, Abdelouaid; Torner, Stephane; Blasco, Gilles; Yannaraki, Maria; Barbar, Saber Davide; Quenot, Jean-Pierre

    2014-11-19

    The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus heparin in terms of event-free survival of the first non-tunneled hemodialysis catheter inserted in ICU patients with AKI requiring RRT. Secondary objectives are the rate of fibrinolysis, incidence of catheter thrombosis and catheter-related infection per 1,000 catheter days, length of stay in ICU and in-hospital and 28-day mortality. The VERROU-REA study is a randomized, prospective, multicenter, double-blind, parallel-group, controlled superiority study carried out in the medical, surgical and nephrological ICUs of two large university hospitals in eastern France. A catheter lock solution composed of trisodium citrate at 4% will be compared to unfractionated heparin at a concentration of 5,000 IU/mL. All consecutive adult patients with AKI requiring extracorporeal RRT, and in whom a first non-tunneled catheter is to be inserted by the jugular or femoral approach, will be eligible. Catheters inserted by the subclavian approach, patients with acute liver failure, thrombopenia or contraindication to systemic anticoagulation will be excluded. Patients will be followed up daily in accordance with standard practices for RRT until death or discharge. Data is scarce regarding the use of non-tunneled catheters in the ICU setting in patients with AKI. This study will provide an evidence base for

  17. Survival during renal replacement therapy of patients previously treated with a very low-protein diet supplemented with ketoacids : the Italian experience.

    Directory of Open Access Journals (Sweden)

    A Cupisti

    2012-06-01

    In conclusion, prescription of sVLPD during the conservative phase of chronic renal failure does not worsen, or even improves, survival after starting RRT. This survival advantage is more evident in patients younger than 70 years.

  18. Meta-analysis of impact of continuous renal replacement therapy dose on outcome of acute renal failure patients%连续性肾脏替代治疗剂量对急性肾衰竭患者预后影响的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    齐华林; 刘峰; 王俊; 余晨; 严海东

    2010-01-01

    目的 通过荟萃分析评价连续性肾脏替代治疗(CRRT)剂量对急性肾衰竭(ARF)患者预后的影响.方法 制定原始文献的纳入标准和检索策略,在Medline、EMBASE及Cochrane图书馆内进行相关的检索.比较标准剂量和低剂量CRRT对ARF患者预后影响的随机对照试验(RCT)纳入分析.应用随机或固定效应模型处理预后指标的相对危险度(RR).结果 6项研究符合纳入标准.与低剂量比较,标准剂量CRRT未能降低病死率(RR0.87,95%CI 0.70~1.07,P=0.19)和联合终点事件(死亡和依赖透析)的发生率(RR0.87,95%CI 0.69~1.09,P=0.21),但有增加依赖透析率的趋势(RR 1.43,95%CI 0.94~2.18,P=0.09).由于研究间存在异质性,亚组分析显示,实际治疗剂量达标(标准剂量>35 ml·kg-1-min-1)、治疗模式以连续性静脉-静脉血液滤过(CVVH)为主(置换液量大于透析液量)、非脓毒症为ARF主要原因(脓毒血症发病率<50%)的研究中,经标准剂量CRRT后病死率显著下降(P<0.01).结论 尽管标准剂量CRRT未能降低ARF患者的病死率、依赖透析率和联合终点事件的发生率,但可改善实际治疗剂量达标、治疗模式以CVVH为主及非脓毒症ARF患者的存活率.%Objective To assess the effect of continuous renal-replacement therapy (CRRT) dose on the outcome of acute renal failure (ARF) patients with meta-analysis of randomized controlled trials (RCTs). Methods Studies were identified by systematic search of peer-reviewed publications in Medline, EMBASE and Cochrane library database through June 2010. All the RCTs that compared the incidence of clinical outcome such as mortality, need for chronic dialysis between standard and low dose CRRT were eligible. The pooled relative risk (RR) for clinical outcome was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup and sensitivity analysis. Results Six eligible studies were identified. By meta-analysis, standard dose CRRT was

  19. Renal failure in patients with left ventricular assist devices.

    Science.gov (United States)

    Patel, Ami M; Adeseun, Gbemisola A; Ahmed, Irfan; Mitter, Nanhi; Rame, J Eduardo; Rudnick, Michael R

    2013-03-01

    Implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require long-term outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.

  20. Modal Indicators for Operational Modal Identification

    DEFF Research Database (Denmark)

    Zhang, L.; Brincker, Rune; Andersen, P.

    2001-01-01

    Modal validation is of paramount importance for all two-stage time domain modal identification algorithms. However, due to a higher noise/signal ratio in operational/ambient modal analysis, being able to determine the right model order and to distinguish between structural modes and computational...... modes become more significant than in traditional modal analysis. The two major modal indicators, i.e. Modal Confidence Factor (MCF) and Modal Amplitude Coherence (MAmC) are extended to two-stage time domain modal identification algorithms, together with a newly developed indicator, named as Modal...... Participation Indicator (MPI). The application of the three indicators is illustrated on different cases of operational/ambient modal identification. Three major time domain modal identification algorithms are used the Polyreference Complex Exponential (PRCE), Extended Ibrahim Time Domain (EITD), Eigensystem...

  1. Avaliação nutricional do cardiopata crítico em terapia de substituição renal: dificuldade diagnóstica Nutritional assessment of the critically ill patients with cardiac disease under renal replacement therapy: diagnostic difficulty

    Directory of Open Access Journals (Sweden)

    Maria das Neves Jardim

    2009-06-01

    Full Text Available OBJETIVO: Realizar avaliação nutricional em pacientes cardiopatas críticos que necessitem de terapia de substituição renal. MÉTODOS: Pacientes cardiopatas críticos, internados em unidade de terapia intensiva, que apresentavam insuficiência renal com indicação de terapia de substituição renal foram submetidos à avaliação nutricional com a utilização de medidas antropométricas e análise laboratorial. RESULTADOS: Foram avaliados 43 pacientes, com idade de 64±15 anos, 26 do sexo masculino. A média da fração de ejeção do ventrículo esquerdo foi de 0,36±0,16. Avaliação do estado nutricional com base no índice de massa corpórea revelou 18 pacientes eutróficos, 6 pacientes com baixo peso, 19 pacientes com sobrepeso ou obesidade. Baseado na medida da prega cutânea tricipital, 16 pacientes eram eutróficos, 27 pacientes apresentaram algum grau de depleção e, com base na circunferência do braço e na circunferência muscular do braço, 41 pacientes apresentaram algum grau de depleção. Dados laboratoriais evidenciaram depleção grave baseado na albumina em 28 pacientes e 27 pacientes tinham depleção grave de acordo com a contagem de linfócitos. CONCLUSÃO: A desnutrição é comum em pacientes cardiopatas críticos em terapia de substituição renal. Avaliação nutricional baseada no índice de massa corpórea não revelou ser bom método para diagnóstico de distúrbios nutricionais nesta população. Há necessidade de complementar a avaliação nutricional para identificação de desnutrição e possibilitar introdução precoce de suporte nutricional adequado.OBJECTIVE: Evaluate the nutritional status of patients with cardiac disease and concomitant renal dysfunction requiring renal replacement therapy. METHODS: Patients with cardiac disease and renal failure receiving renal replacement therapy, admitted to an intensive care unit, were submitted to nutritional evaluation, by use of anthropometric measurements

  2. Imaging of renal osteodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Jevtic, V. E-mail: vladimir.jevtic@mf.uni-lj.si

    2003-05-01

    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

  3. Digital subtaction angiography (DSA) in renal-related conditions

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Ho; Jeong, Seong Wook; Bae, Kwang Soo; Chung, Moo Chan; Kim, Ki Jeong [Soon Chun Hyang University College of Medicine, Asan (Korea, Republic of)

    1986-10-15

    DSA (Digital Subtraction Angiography) is a valuable diagnostic imaging method in many clinical fields, including renal-related conditions. Sixty four renal DSA examination were performed in 59 patients with renal-related diseases from Jan. 1984 to Dec. 1985. Summary of These were as follows: 1. Intraarterial(IA)-DSA is performed in 6 cases, intravenous(IV)-DSA in 58 cases. In 58 Examinations of IV-DSA, diagnostic image quality is obtained in 51 cases (88%). 2. In investigations of a possible renovascular etiology of hypertension, IV-DSA is a simple, safe, sensitive and accurate method. On screening for evaluation of renovascular hypertension, RSP should be replaced with IV-DSA, because IV-DSA is more sensitive and accurate and can detect not only anatomic change of renal artery but also functional hemodynamic change. 3. IV-DSA is valuable in diseases with morphologic changes of vessels. In characterization of a known renal mass, and evaluation of hematuria, suspected aneurysm and renal trauma, IV-DSA is very useful diagnostic imaging modality. 4. In evaluation of potential renal donors, IV-DSA is an accurate and safe method with 82.4% of accuracy. IV-DSA also is useful in follow-up of allograft recipients. 5. In investigation of diabetic nephropathy, glomerulonephritis, pyelonephritis, IV-DSA is little helpful. 6. The advantages of DSA are well known, particularly post-procedure process using computer program is helpful for obtaining information's of hemodynamic change or time-suquence-curve of density etc. More technical improvement with this modality is required for improvement of the image quality and resolution. And more accumulation of clinical experience is required in order to increase the diagnostic accuracy.

  4. Renal tubule cell repair following acute renal injury.

    Science.gov (United States)

    Humes, H D; Lake, E W; Liu, S

    1995-01-01

    Experimental data suggests the recovery of renal function after ischemic or nephrotoxic acute renal failure is due to a replicative repair process dependent upon predominantly paracrine release of growth factors. These growth factors promote renal proximal tubule cell proliferation and a differentiation phase dependent on the interaction between tubule cells and basement membrane. These insights identify the molecular basis of renal repair and ischemic and nephrotoxic acute renal failure, and may lead to potential therapeutic modalities that accelerate renal repair and lessen the morbidity and mortality associated with these renal disease processes. In this regard, there is a prominent vasoconstrictor response of the renal vasculature during the postischemic period of developing acute renal failure. The intravenous administration of pharmacologic doses of atrial natriuretic factor (ANF) in the postischemic period have proven efficacious by altering renal vascular resistance, so that renal blood flow and glomerular filtration rate improve. ANF also appears to protect renal tubular epithelial integrity and holds significant promise as a therapeutic agent in acute renal failure. Of equal or greater promise are the therapeutic interventions targeting the proliferative reparative zone during the postischemic period. The exogenous administration of epidermal growth factor or insulin-like growth factor-1 in the postischemic period have effectively decreased the degree of renal insufficiency as measured by the peak serum creatinine and has hastened renal recovery as measured by the duration of time required to return the baseline serum creatinine values. A similarly efficacious role for hepatocyte growth factor has also been recently demonstrated.

  5. Experimental modal analysis

    Energy Technology Data Exchange (ETDEWEB)

    Ibsen, Lars Bo; Liingaard, M.

    2006-12-15

    This technical report concerns the basic theory and principles for experimental modal analysis. The sections within the report are: Output-only modal analysis software, general digital analysis, basics of structural dynamics and modal analysis and system identification. (au)

  6. Hypertension in children with end-stage renal disease.

    Science.gov (United States)

    Roszkowska-Blaim, Maria; Skrzypczyk, Piotr

    2015-09-01

    This review summarizes current data on the epidemiology, pathophysiology, and treatment of hypertension (HTN) in children with end-stage renal disease (ESRD). Worldwide prevalence of ESRD ranges from 5.0 to 84.4 per million age-related population. HTN is present in 27-79% of children with ESRD, depending on the modality of renal replacement therapy and the exact definition of hypertension. Ambulatory BP monitoring has been recommended for the detection of HTN and evaluation of treatment effectiveness. HTN in dialyzed patients is mostly related to hypervolemia, sodium overload, activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, impaired nitric oxide synthesis, reduced vitamin D levels, and effects of microRNA. In children undergoing chronic dialysis therapy, important factors include optimization of renal replacement therapy and preservation of residual renal function, allowing reduction of volume- and sodium-overload, along with appropriate drug treatment, particularly with calcium channel blockers, RAAS inhibitors, and loop diuretics.

  7. Association of Hypothyroidism with Body Mass Index, Systolic Blood Pressure and Proteinuria in Diabetic Patients: Does treated Hypothyroidism with Thyroxine Replacement Therapy Prevent Nephropathy/Chronic Renal Disease?

    Science.gov (United States)

    Aziz, Kamran M A

    2016-01-01

    Untreated or sub-clinical hypothyroidism is associated with insulin resistance, obesity, adverse effects on cardiovascular system, hypertension and in turn risk of nephropathy. However, these changes are reversible with thyroxine replacement therapy (TRT). Current research studied 4235 diabetic patients, divided into two groups, those with clinical hypothyroidism /on TRT, compared to those without thyroid disease or undiagnosed. BMI, blood pressure, creatinine, urine microalbumin and spot urine protein levels were compared between these two groups. Study finding demonstrated that for hypothyroid cases, BMI was higher (32.2 ± 7.44 versus 29.4 ± 5.7; p hypothyroidism (on TRT) was strongly associated with obesity (p hypothyroidism.

  8. Ankle replacement

    Science.gov (United States)

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections in ...

  9. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  10. Modal Epistemology and Conceivability

    DEFF Research Database (Denmark)

    Philosophical argumentation often depends on modal facts, i.e. facts about what is possible, contingent, or necessary. For thought and cognition outside the domain of philosophy modal facts are also often decisive. It seems we have an easy access to modal facts, but how so? Through a presentation...... of the state-of-the-art in modal epistemology I wish to outline a research project based on conceivability that will try to explain how we come to know modal facts....

  11. SHECTS multi-centre Spanish study: liver situation of patients with chronic hepatitis from HCV on renal replacement therapy with haemodialysis.

    Science.gov (United States)

    García-Agudo, Rebeca; Aoufi-Rabih, Sami; Barril-Cuadrado, Guillermina

    2013-01-01

    The SHECTS study, approved by the Spanish Society of Nephrology, has the goal of analysing the level of examination and follow-up of patients with chronic hepatitis C virus (HCV) infections on haemodialysis, and to determine the current prevalence of these patients. A national, multi-centre, cohort study carried out between September 2010 and September 2011. We sent a data collection folder to all Spanish haemodialysis units to include information regarding each centre and the nephrological/hepatological situation of their HCV-positive patients. A total of 187 haemodialysis units (71 hospital-based) participated in the study. The global prevalence of HCV was estimated at 5.6%. The most common cause of chronic kidney disease was glomerular (25%); of the 72.1% of patients who had undergone a renal biopsy, 23.2% had glomerulonephritis that could have been associated with HCV. Genotyping had not been carried out in 64%, liver ultrasound had not been applied in 61.3%, and liver biopsies were not performed in 87.7%. One-third of all patients received care from a gastroenterologist. Antiviral treatment was administered to 26.6% of patients, with a sustained viral response in 35.3% and suspension of treatment in 67.4%. The prevalence of HCV in patients on haemodialysis in Spain has decreased to the point of reaching similar rates to those of neighbouring countries. These patients receive incomplete analyses of liver condition, and individuals who receive antiviral treatment and untreated patients constitute a large proportion, despite having low viral loads and being candidates for kidney transplants.

  12. Analysis of data from the ERA-EDTA Registry indicates that conventional treatments for chronic kidney disease do not reduce the need for renal replacement therapy in autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Spithoven, Edwin M; Kramer, Anneke; Meijer, Esther; Orskov, Bjarne; Wanner, Christoph; Caskey, Fergus; Collart, Frederic; Finne, Patrik; Fogarty, Damian G; Groothoff, Jaap W; Hoitsma, Andries; Nogier, Marie-Béatrice; Postorino, Maurizio; Ravani, Pietro; Zurriaga, Oscar; Jager, Kitty J; Gansevoort, Ron T

    2014-12-01

    Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney failure, but is often identified early and therefore amenable to timely treatment. Interventions known to postpone the need for renal replacement therapy (RRT) in non-ADPKD patients have also been tested in ADPKD patients, but with inconclusive results. To help resolve this we determined changes in RRT incidence rates as an indicator for increasing effective renoprotection over time in ADPKD. We analyzed data from the European Renal Association-European Dialyses and Transplant Association Registry on 315,444 patients starting RRT in 12 European countries between 1991 and 2010, grouped into four 5-year periods. Of them, 20,596 were due to ADPKD. Between the first and last period the mean age at onset of RRT increased from 56.6 to 58.0 years. The age- and gender-adjusted incidence rate of RRT for ADPKD increased slightly over the four periods from 7.6 to 8.3 per million population. No change over time was found in the incidence of RRT for ADPKD up to age 50, whereas in recent time periods the incidence in patients above the age of 70 clearly increased. Among countries there was a significant positive association between RRT take-on rates for non-ADPKD kidney disease and ADPKD. Thus, the increased age at onset of RRT is most likely due to an increased access for elderly ADPKD patients or lower competing risk prior to the start of RRT rather than the consequence of effective emerging renoprotective treatments for ADPKD.

  13. Characterization of complex renal cysts

    DEFF Research Database (Denmark)

    Graumann, Ole; Osther, Susanne Sloth; Osther, Palle Jörn Sloth

    2010-01-01

    Abstract Objective. Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification system, based on computed tomography (CT), is widely used to categorize cystic renal lesions. The aim of this study was to evaluate critically ...... of this "new" classification strategy is, however, still missing. Data on other imaging modalities are too limited for conclusions to be drawn.......Abstract Objective. Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification system, based on computed tomography (CT), is widely used to categorize cystic renal lesions. The aim of this study was to evaluate critically...... available data on the Bosniak classification. Material and methods. All publications from an Entrez Pubmed search were reviewed, focusing on clinical applicability and the use of imaging modalities other than CT to categorize complex renal cysts. Results. Fifteen retrospective studies were found. Most...

  14. 对肝移植术后急性肾功能衰竭患者应用无肝素连续性肾脏替代治疗的护理%Nursing on Patients with Acute Renal Failure after Liver Transplantation in the Application of Heparin-free Continuous Renal Replacement Treatment

    Institute of Scientific and Technical Information of China (English)

    张海霞; 王丽文

    2014-01-01

    根据肝移植患者术后发生急性肾功能衰竭的个体特殊性进行无肝素连续性肾脏替代治疗方法的选择。本文主要概述了治疗前的护理要点,治疗过程中的监测和护理要点以及治疗后的护理要点,总结出无肝素CRRT过程中的护理要求。%According to the individual particularity of patients with acute renal failure after liver transplanta-tion, choose the method of heparin-free continuous renal replacement treatment (CRRT). This article mainly reviews the nursing points before treatment, monitoring and nursing points in the course of treatment, nursing points after treat-ment, and summarizes the nursing requirements in the process of heparin-free CRRT.

  15. The doripenem serum concentrations in intensive care patients suffering from acute kidney injury, sepsis, and multi organ dysfunction syndrome undergoing continuous renal replacement therapy slow low-efficiency dialysis

    Directory of Open Access Journals (Sweden)

    Wieczorek A

    2014-10-01

    Full Text Available Andrzej Wieczorek, Andrzej Tokarz, Wojciech Gaszynski, Tomasz Gaszynski Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland Abstract: Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300–400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT slow low-efficiency dialysis (SLED on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis. Ten patients were enrolled in this observational study. Twelve blood samples were collected during the first administration of doripenem in a 1-hour continuous infusion while CRRT SLED was provided. Fluid chromatography was used for measurement of the concentration of doripenem in serum. In all collected samples, concentration of doripenem was above the minimum inhibition concentration of this antibiotic. Based on these results, we can draw the conclusion that doripenem concentration is above the minimum inhibition ­concentration throughout all of CRRT. The dosing pattern proposed by the manufacturer can be used in patients receiving CRRT SLED without necessary modifications. Keywords: AKI, antibiotic, antimicrobial therapy, carbapenem, CRRT, infection, MODS, SLED

  16. The doripenem serum concentrations in intensive care patients suffering from acute kidney injury, sepsis, and multi organ dysfunction syndrome undergoing continuous renal replacement therapy slow low-efficiency dialysis.

    Science.gov (United States)

    Wieczorek, Andrzej; Tokarz, Andrzej; Gaszynski, Wojciech; Gaszynski, Tomasz

    2014-01-01

    Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300-400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT) slow low-efficiency dialysis (SLED) on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis. Ten patients were enrolled in this observational study. Twelve blood samples were collected during the first administration of doripenem in a 1-hour continuous infusion while CRRT SLED was provided. Fluid chromatography was used for measurement of the concentration of doripenem in serum. In all collected samples, concentration of doripenem was above the minimum inhibition concentration of this antibiotic. Based on these results, we can draw the conclusion that doripenem concentration is above the minimum inhibition concentration throughout all of CRRT. The dosing pattern proposed by the manufacturer can be used in patients receiving CRRT SLED without necessary modifications.

  17. Renal tuberculosis

    Directory of Open Access Journals (Sweden)

    Džamić Zoran

    2016-01-01

    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  18. Série histórica de custos com terapia de substituição renal no município do Rio de Janeiro (1995-2009 Serie histórica de costes con terapia de reemplazo renal en la ciudad de Rio de Janeiro (1995-2009 Time series of costs of renal replacement therapy in Rio de Janeiro city (1995-2009

    Directory of Open Access Journals (Sweden)

    Genesis de Souza Barbosa

    2013-06-01

    Full Text Available Objetivou-se avaliar a tendência temporal do custo total de terapia de substituição renal e a proporção entre custo e solicitações de Autorizações de Procedimentos Ambulatoriais de Alta Complexidade/Custo no município do Rio de Janeiro, entre 1995 e 2009, em totais e segundo prestador. Estudo quantitativo, descritivo, tipo série temporal. Utilizaram-se informações referentes aos valores e quantidades de autorizações de procedimentos de alta complexidade para terapia de substituição renal por ano, disponíveis no DATASUS, coletadas entre fevereiro e março de 2011. Observou-se tendência crescente para o custo total e o total de autorizações destes procedimentos (y=3,8414x + 16,904, R²=0,9665 e y=14519x + 299719, R²=0,8835, respectivamente. Há uma diferença estatisticamente significativa (pEl objetivo del estudio fue evaluar la tendencia temporal del coste total de terapia de reemplazo renal y la proporción entre coste y solicitaciones de Autorizaciones de Procedimientos en Ambulatorio de Alta Complejidad/Coste en la cuidad de Rio de Janeiro, entre 1995 y 2009, en total y segundo proveedor. Estudio cuantitativo, descriptivo, de serie temporal. Se utilizó la información relativa a los valores y las cantidades de los procedimientos de permisos de alta complejidad para la terapia de reemplazo renal por año, disponible en DATASUS, recolectadas desde febrero y marzo de 2011. Se observó una tendencia creciente para el coste total y el total de permisos de estos procedimientos (y = 3,8414x + 16,904, R² = 0,9665 e y = 14519x + 299719, R² = 0,8835, respectivamente. Hay una diferencia estadísticamente significativa (pThe study objective was to evaluate the temporal tendency of the final cost of renal replacement therapy and also to evaluate the ratio between a procedure cost and its requests on the High Complexity Outpatient Procedures Authorization/Cost in the city of Rio de Janeiro, between 1995 and 2009 in totals and as

  19. Directed Replacement

    CERN Document Server

    Karttunen, L

    1996-01-01

    This paper introduces to the finite-state calculus a family of directed replace operators. In contrast to the simple replace expression, UPPER -> LOWER, defined in Karttunen (ACL-95), the new directed version, UPPER @-> LOWER, yields an unambiguous transducer if the lower language consists of a single string. It transduces the input string from left to right, making only the longest possible replacement at each point. A new type of replacement expression, UPPER @-> PREFIX ... SUFFIX, yields a transducer that inserts text around strings that are instances of UPPER. The symbol ... denotes the matching part of the input which itself remains unchanged. PREFIX and SUFFIX are regular expressions describing the insertions. Expressions of the type UPPER @-> PREFIX ... SUFFIX may be used to compose a deterministic parser for a ``local grammar'' in the sense of Gross (1989). Other useful applications of directed replacement include tokenization and filtering of text streams.

  20. Experimental modal analysis

    DEFF Research Database (Denmark)

    Ibsen, Lars Bo; Liingaard, Morten

    This technical report concerns the basic theory and principles for experimental modal analysis. The sections within the report are: Output-only modal analysis software (section 1.1), general digital analysis (section 1.2), basics of structural dynamics and modal analysis (section 1.3) and system ...

  1. NIF Periscope Wall Modal Study Comparison of Results for 2 FEA Models with 2 Modal Tests

    Energy Technology Data Exchange (ETDEWEB)

    Eli, M W; Gerhard, M A; Lee, C L; Sommer, S C; Woehrle, T G

    2000-10-26

    This report summarizes experimentally and numerically determined modal properties for one of the reinforced concrete end walls of the NIF Periscope Support Structure in Laser Bay 1. Two methods were used to determine these modal properties: (1) Computational finite-element analyses (modal extraction process); and (2) Experimental modal analysis based on measured test data. This report also includes experimentally determined modal properties for a prototype LM3/Polarizer line-replaceable unit (LRU) and a prototype PEPC LRU. Two important parameters, used during the design phase, are validated through testing [ref 1]. These parameters are the natural frequencies and modal damping (of the system in question) for the first several global modes of vibration. Experimental modal testing provides these modal values, along with the corresponding mode shapes. Another important parameter, the input excitation (expected during normal operation of the NIF laser system) [ref 1], can be verified by performing a series of ambient vibration measurements in the vicinity of the particular system (or subsystem) of interest. The topic of ambient input excitation will be covered in a separate report. Due to the large mass of the Periscope Pedestal, it is difficult to excite the entire series of Periscope Pedestal Walls all at once. It was decided that the experimental modal tests would be performed on just one Periscope End Wall in Laser Bay 1. Experimental modal properties for the Periscope End Wall have been used to validate and update the FE analyses. Results from the analyses and modal tests support the conclusion that the Periscope Pedestal will not exceed the stability budget, which is described in reference 1. The results of the modal tests for the Periscope End Wall in Laser Bay 1 have provided examples of modal properties that can be derived from future modal tests of the entire Periscope Assembly (excluding the LRU's). This next series of larger modal tests can be

  2. Husserl’s Modal Sense of Evidence: Modality versus Modalization

    Directory of Open Access Journals (Sweden)

    Ivana Anton

    2013-12-01

    Full Text Available Phenomenological evidence has been characterized as fulfillment of a meaning intention, comprehension that tends to assimilate evidence to fulfilled consciousness, without making justice to the essential and mutual implication of emptiness and fullness that constitutes it out of its horizontic-intentional kind. The horizon, typically configured, offers the field of possible fulfillment; that is why it can be said that evidence takes place in a consciousness of possibility, namely, a modal one, though in an originary material and not doxic or positional sense,because it is the first one that is incumbent upon relationships of fulfillment. Modality that essentially characterizes evidence does not reveal itself then in the possible modalization as positional modification of a unitary content, but in its “outlined” material configuration of fullness and emptiness that gives somethingas something referring to other possibilities as moments of its own validity.

  3. Operational Modal Analysis Tutorial

    DEFF Research Database (Denmark)

    Brincker, Rune; Andersen, Palle

    analysis in an easier way and in many cases more effectively than traditional modal analysis methods. It can be applied for modal testing and analysis on a wide range of structures and not only for problems generally investigated using traditional modal analysis, but also for those requiring load......In this paper the basic principles in operational modal testing and analysis are presented and discussed. A brief review of the techniques for operational modal testing and identification is presented, and it is argued, that there is now a wide range of techniques for effective identification...... estimation, vibration level estimation and fatigue analysis....

  4. Knee Replacement

    Science.gov (United States)

    ... need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some ... a total living space on one floor since climbing stairs can be difficult. Install safety bars or a ...

  5. Replacing penalties

    Directory of Open Access Journals (Sweden)

    Vitaly Stepashin

    2017-01-01

    Full Text Available УДК 343.24The subject. The article deals with the problem of the use of "substitute" penalties.The purpose of the article is to identify criminal and legal criteria for: selecting the replacement punishment; proportionality replacement leave punishment to others (the formalization of replacement; actually increasing the punishment (worsening of legal situation of the convicted.Methodology.The author uses the method of analysis and synthesis, formal legal method.Results. Replacing the punishment more severe as a result of malicious evasion from serving accused designated penalty requires the optimization of the following areas: 1 the selection of a substitute punishment; 2 replacement of proportionality is serving a sentence other (formalization of replacement; 3 ensuring the actual toughening penalties (deterioration of the legal status of the convict. It is important that the first two requirements pro-vide savings of repression in the implementation of the replacement of one form of punishment to others.Replacement of punishment on their own do not have any specifics. However, it is necessary to compare them with the contents of the punishment, which the convict from serving maliciously evaded. First, substitute the punishment should assume a more significant range of restrictions and deprivation of certain rights of the convict. Second, the perfor-mance characteristics of order substitute the punishment should assume guarantee imple-mentation of the new measures.With regard to replacing all forms of punishment are set significant limitations in the application that, in some cases, eliminates the possibility of replacement of the sentence, from serving where there has been willful evasion, a stricter measure of state coercion. It is important in the context of the topic and the possibility of a sentence of imprisonment as a substitute punishment in cases where the original purpose of the strict measures excluded. It is noteworthy that the

  6. Assessment of Nutrition and Fluid Status in Renal Replacement Therapy in Patients Using Bioimpedance Analysis%BIA在评估肾替代治疗患者营养及体液状况中的应用

    Institute of Scientific and Technical Information of China (English)

    刘俊成

    2011-01-01

    如何正确评估肾替代治疗(主要包括血液透析及腹膜透析)患者的营养及体液状况一直是临床医师面临的难题.近年来生物电阻抗分析法在评估肾替代患者营养及体液状况方面受到较多的关注.它是基于电学方法测定的技术,建立在人体不同组织电阻不同的基础上,通过测量人体营养及体液相关指标来进行分析.与传统的方法相比,生物电阻抗分析法具有非侵入性、便携性、重复性好、操作简单、患者易接受等优点.现就此进展予以综述.%How to properly assess the nutrition and body fluid status in patients with renal replacement ( including hemodialysis and peritoneal dialysis )therapy has always been challenges faced by the clinicians,where bioelectrical impedance analysis( BIA )received more attention in recent years.BIA is a technology based on electrical methods and different resistance of different human tissues,which works by measuring human nutrition and body fluid related index.Compared with traditional methods, BIA is non-invasive, convenient, repeatable, easily operated and accepted by patients.Here is to review the progress.

  7. Effect of early recanalization on filter clotting in continuous renal replacement therapy%早期再通技术对连续性肾脏替代治疗中滤器凝血的影响

    Institute of Scientific and Technical Information of China (English)

    万方; 熊杰; 刘伟权

    2011-01-01

    目的 探讨早期再通技术对连续性肾脏替代治疗(CRRT)中出现滤器凝血的影响.方法 28例CRRT治疗中出现滤器凝血征兆患者,早期给予再通技术,并记录操作前后跨膜压、滤器下降压、回路静脉压、废液压数值的变化.结果 滤器凝血征兆消失,跨膜压、滤器下降压、回路静脉压数值下降,废液压数值增高,与操作前比较,差异有统计学意义(P<0.01),无破膜漏血现象.结论 早期对滤器凝血采取护理干预,可延长滤器寿命,保证治疗措施有效落实,减低患者经济负担.%Objective To explore the effect of early recanalization on filter clotting in continuous renal replacement therapy (CRRT). Methods Twenty-eight patients with the indication of filter clotting in CRRT received early recanalization. Transmembrane pressure, filter drop pressure, return pressure and effluent pressure before and after the recanalization were recorded. Results Filter clotting symptoms disappeared; the transmembrane pressure, filter drop pressure and return pressure decreased remarkably and the effluent pressure increased significantly, which had statistically significance compared that before the operation ( P < 0.01 );rupture of the membrane and blood loss did not occur . Conclusions Early nursing intervention to the filter clotting shall be conducted to prolong the lifespan of the filter, guarantee the remedial measures to be carried out effectively and lessen the patient's economic burden.

  8. Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II.

    Science.gov (United States)

    González-Castro, A; Ortiz-Lasa, M; Leizaola, O; Salgado, E; Irriguible, T; Sánchez-Satorra, M; Lomas-Fernández, C; Barral-Segade, P; Cordero-Vallejo, M; Rodrigo-Calabia, E; Dierssen-Sotos, T

    2017-05-01

    To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Nursing for Patients with Liver Transplantation by Heparin-free Continuous Renal Replacement Treatment%无肝素连续性肾脏替代治疗肝移植患者的护理

    Institute of Scientific and Technical Information of China (English)

    王微娜; 周淑亚; 徐雅玲; 袁静

    2014-01-01

    Objective To analyze the nursing methods of heparin-free continuous renal replacement treatment (CRRT) in patients with liver transplantation. Methods Observe and analyze the application of heparin-free CRRT in 21 patients with liver transplantation in the blood purification center, the First Affiliated Hospital of Zhejiang University in 2013. Results Only 2 of 21 patients used 2-3 pipelines and filters of hemodialysis in 24 h, the others were successful during the dialysis. Conclusion Liver-transplanted patients with hemorrhagic tendency are related to surgical trauma, blood coagulation dysfunction, and platelet depletion, thereby, heparin-free CRRT is one of the effective therapies. And the correct nursing method is the safety guarantee of liver-transplanted patients.%目的:分析肝移植患者无肝素CRRT配合治疗的护理要点。方法收集我院2013年的21例肝移植患者无肝素CRRT配合治疗的护理情况进行分析。结果21例患者中仅有2例患者24 h需用2-3套管路及滤器,其余19例患者治疗过程顺利。结论肝移植患者由于手术创伤、凝血功能障碍、血小板消耗等原因,容易发生出血现象。因此,无肝素的CRRT治疗对肝移植的患者来说是最有效的方法之一。正确的无肝素护理技术是肝移植患者行CRRT治疗的保障。

  10. Renal arteriography

    Science.gov (United States)

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  11. Unaffordability of renal replacement therapy in Nigeria

    Directory of Open Access Journals (Sweden)

    Samuel Ajayi

    2016-04-01

    在全世界,糖尿病的盛行率與日俱增,然而對於發展中國家如尼日利亞,基礎醫療架構並不足以應付患者對腎置換療法 (RRT 的需求。本地民眾必須自費支付自身的醫療費用,但其收入水平遠不足以負擔慢性腎病二級與三級照護所需的 RRT。即使目前 RRT 設施已有所增加,但無論是患者或政府均難以維持治療的長期實施。此外,腎臟移植所需的資源在本地更是相當之有限。在被我們納入透析計劃的末期腎病 (ESKD 患者間,大多數並未能接受足夠或持續的透析治療。過去十年間,在我們設施內接受透析的病人中,年齡分佈大致穩定,且男性佔較多數。目前,我們正研究如何能促進 RRT 普及實施的方案。透過謹慎的理財與成本控制、透析物料的本土生產、及非政府資金的運用,透析的相關費用可望得以降低。目前,發展中國家如尼日利亞的藥物與醫療器材大多仰賴進口,因此相關物資的本土生產是降低醫療成本的可行方案。

  12. [Renal cell carcinoma secondary to tuberculous nephritis].

    Science.gov (United States)

    El Mejjad, Amine; Fekak, Hamid; Debbagh, Adili; Joual, Abdenbi; Bennani, Saad; El Mrini, Mohamed

    2005-04-01

    The combination of renal tuberculosis and renal cancer is rare. The authors report the case of a patient who was followed for multifocal pulmonary, hepatic and renal tuberculosis. The diagnosis of associated renal tumour was raised in the presence of suggestive radiological images. Tumourectomy was performed after tuberculostatic therapy, and histological examination revealed renal cell carcinoma associated with caseo-follicular tuberculous granulomas. The outcome was favourable after a follow-up of 2 years. The objective of this study is to analyse the pathogenesis, diagnostic features and treatment modalities of this exceptional combination.

  13. Operational Modal Analysis Tutorial

    OpenAIRE

    Brincker, Rune; Andersen, Palle

    2007-01-01

    In this paper the basic principles in operational modal testing and analysis are presented and discussed. A brief review of the techniques for operational modal testing and identification is presented, and it is argued, that there is now a wide range of techniques for effective identification of modal parameters of practical interest - including the mode shape scaling factor - with a high degree of accuracy. It is also argued that the operational technology offers the user a number of advanta...

  14. Modal extension rule

    Institute of Scientific and Technical Information of China (English)

    WU Xia; SUN Jigui; LIN Hai; FENG Shasha

    2005-01-01

    Modal logics are good candidates for a formal theory of agents. The efficiency of reasoning method in modal logics is very important, because it determines whether or not the reasoning method can be widely used in systems based on agent. In this paper,we modify the extension rule theorem proving method we presented before, and then apply it to P-logic that is translated from modal logic by functional transformation. At last, we give the proof of its soundness and completeness.

  15. Anticoagulant Therapy for Patients with Acute Renal Failure After Cardiac Valve Replacement by Clinical Pharmacists%临床药师参与心脏瓣膜置换术后并发急性肾衰竭患者的抗凝治疗

    Institute of Scientific and Technical Information of China (English)

    成云兰; 夏宗玲

    2016-01-01

    目的:探讨临床药师参与心脏瓣膜置换术后并发急性肾衰竭患者的抗凝治疗、协助医师制订连续肾脏替代疗法(continuous renal replacement therapy ,CRRT)用药方案的实践。方法:临床药师参与3例典型心脏瓣膜置换术后并发急性肾衰竭患者的药物治疗过程,阐明心脏瓣膜置换术后并发急性肾衰竭的三大常见原因及其CRRT抗凝治疗方案,根据不同病因制订个体化的CRRT抗凝方案,并跟进治疗效果,提供药学服务,调整治疗方案。结果:医师接受了临床药师的治疗建议,患者治疗过程顺利,病情好转出院。结论:临床药师根据自身掌握的疾病病理生理特点和药学知识,可以有效地协助医师确立更适当的个体化治疗方案。%OBJECTIVE:To probe into the participation of clinical pharmacists in anticoagulant therapy for patients with acute renal failure after cardiac valve replacement , and the assist for clinicians in formulation of medication scheme of continuous renal replacement therapy (CRRT).METHODS: The clinical pharmacists participated into the whole therapeutic process of three patients with acute renal failure after typical cardiac valve replacement , explained three common causes of acute renal failure after typical cardiac valve replacement and the CRRT anticoagulant therapy scheme and formulated the individualized scheme according to different causes , so as to provide pharmaceutical care for patients and adjust the therapeutic scheme .RESULTS: The clinicians received the suggestions provided by the clinical pharmacists .The patients got better and discharged from hospital .CONCLUSIONS: The clinical pharmacists can effectively assist the clinicians to establish more appropriate individualized therapeutic scheme according to their own mastery of disease pathology physiology characteristics and the medicine knowledge .

  16. Hypogonadism and renal failure: An update

    OpenAIRE

    Nannan Thirumavalavan; Wilken, Nathan A.; Ranjith Ramasamy

    2015-01-01

    The prevalence of both hypogonadism and renal failure is increasing. Hypogonadism in men with renal failure carries with it significant morbidity, including anemia and premature cardiovascular disease. It remains unclear whether testosterone therapy can affect the morbidity and mortality associated with renal failure. As such, in this review, we sought to evaluate the current literature addressing hypogonadism and testosterone replacement, specifically in men with renal failure. The articles ...

  17. Hypogonadism and renal failure: An update

    OpenAIRE

    Nannan Thirumavalavan; Nathan A Wilken; Ranjith Ramasamy

    2015-01-01

    The prevalence of both hypogonadism and renal failure is increasing. Hypogonadism in men with renal failure carries with it significant morbidity, including anemia and premature cardiovascular disease. It remains unclear whether testosterone therapy can affect the morbidity and mortality associated with renal failure. As such, in this review, we sought to evaluate the current literature addressing hypogonadism and testosterone replacement, specifically in men with renal failure. The articles ...

  18. Esophageal replacement.

    Science.gov (United States)

    Kunisaki, Shaun M; Coran, Arnold G

    2017-04-01

    This article focuses on esophageal replacement as a surgical option for pediatric patients with end-stage esophageal disease. While it is obvious that the patient׳s own esophagus is the best esophagus, persisting with attempts to retain a native esophagus with no function and at all costs are futile and usually detrimental to the overall well-being of the child. In such cases, the esophagus should be abandoned, and the appropriate esophageal replacement is chosen for definitive reconstruction. We review the various types of conduits used for esophageal replacement and discuss the unique advantages and disadvantages that are relevant for clinical decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Advances in Modal Logic

    DEFF Research Database (Denmark)

    Modal logic is a subject with ancient roots in the western logical tradition. Up until the last few generations, it was pursued mainly as a branch of philosophy. But in recent years, the subject has taken new directions with connections to topics in computer science and mathematics. This volume...... is the proceedings of the conference of record in its fi eld, Advances in Modal Logic. Its contributions are state-of-the-art papers. The topics include decidability and complexity results for specifi c modal logics, proof theory of modal logic, logics for reasoning about time and space, provability logic, dynamic...... epistemic logic, and the logic of evidence....

  20. Laparoscopic Renal Cryoablation

    Science.gov (United States)

    Schiffman, Marc; Moshfegh, Amiel; Talenfeld, Adam; Del Pizzo, Joseph J.

    2014-01-01

    In light of evidence linking radical nephrectomy and consequent suboptimal renal function to adverse cardiovascular events and increased mortality, research into nephron-sparing techniques for renal masses widely expanded in the past two decades. The American Urological Association (AUA) guidelines now explicitly list partial nephrectomy as the standard of care for the management of T1a renal tumors. Because of the increasing utilization of cross-sectional imaging, up to 70% of newly detected renal masses are stage T1a, making them more amenable to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. Cryosurgery has emerged as a leading option for renal ablation, and compared with surgical techniques it offers benefits in preserving renal function with fewer complications, shorter hospitalization times, and allows for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow-up data available. Cryosurgical recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with a solitary kidney. As more data emerge on oncologic efficacy, and technical experience and the technology continue to improve, the application of this modality will likely be extended in future treatment guidelines. PMID:24596441

  1. Selective delivery of IFN-γ to renal interstitial myofibroblasts : a novel strategy for the treatment of renal fibrosis

    NARCIS (Netherlands)

    Poosti, Fariba; Bansal, Ruchi; Yazdani, Saleh; Prakash, Jai; Post, Eduard; Klok, Pieter; van den Born, Jacob; de Borst, Martin H.; van Goor, Harry; Poelstra, Klaas; Hillebrands, Jan-Luuk

    2015-01-01

    Renal fibrosis leads to end-stage renal disease demanding renal replacement therapy because no adequate treatment exists. IFN-γ is an antifibrotic cytokine that may attenuate renal fibrosis. Systemically administered IFN-γ causes side effects that may be prevented by specific drug targeting. Interst

  2. Selective delivery of IFN-γ to renal interstitial myofibroblasts: a novel strategy for the treatment of renal fibrosis

    NARCIS (Netherlands)

    Poosti, Fariba; Bansal, Ruchi; Yazdani, Saleh; Prakash, Jai; Post, Eduard; Klok, Pieter; van den Born, Jacob; de Borst, Martin H.; van Goor, Harry; Poelstra, Klaas; Hillebrands, Jan-Luuk

    2015-01-01

    Renal fibrosis leads to end-stage renal disease demanding renal replacement therapy because no adequate treatment exists. IFN-γ is an antifibrotic cytokine that may attenuate renal fibrosis. Systemically administered IFN-γ causes side effects that may be prevented by specific drug targeting.

  3. Selective delivery of IFN-γ to renal interstitial myofibroblasts : a novel strategy for the treatment of renal fibrosis

    NARCIS (Netherlands)

    Poosti, Fariba; Bansal, Ruchi; Yazdani, Saleh; Prakash, Jai; Post, Eduard; Klok, Pieter; van den Born, Jacob; de Borst, Martin H.; van Goor, Harry; Poelstra, Klaas; Hillebrands, Jan-Luuk

    Renal fibrosis leads to end-stage renal disease demanding renal replacement therapy because no adequate treatment exists. IFN-γ is an antifibrotic cytokine that may attenuate renal fibrosis. Systemically administered IFN-γ causes side effects that may be prevented by specific drug targeting.

  4. Hypogonadism and renal failure: An update

    Directory of Open Access Journals (Sweden)

    Nannan Thirumavalavan

    2015-01-01

    Full Text Available The prevalence of both hypogonadism and renal failure is increasing. Hypogonadism in men with renal failure carries with it significant morbidity, including anemia and premature cardiovascular disease. It remains unclear whether testosterone therapy can affect the morbidity and mortality associated with renal failure. As such, in this review, we sought to evaluate the current literature addressing hypogonadism and testosterone replacement, specifically in men with renal failure. The articles chosen for this review were selected by performing a broad search using Pubmed, Embase and Scopus including the terms hypogonadism and renal failure from 1990 to the present. This review is based on both primary sources as well as review articles. Hypogonadism in renal failure has a multifactorial etiology, including co-morbid conditions such as diabetes, hypertension, old age and obesity. Renal failure can lead to decreased luteinizing hormone production and decreased prolactin clearance that could impair testosterone production. Given the increasing prevalence of hypogonadism and the potential morbidity associated with hypogonadism in men with renal failure, careful evaluation of serum testosterone would be valuable. Testosterone replacement therapy should be considered in men with symptomatic hypogonadism and renal failure, and may ameliorate some of the morbidity associated with renal failure. Patients with all stages of renal disease are at an increased risk of hypogonadism that could be associated with significant morbidity. Testosterone replacement therapy may reduce some of the morbidity of renal failure, although it carries risk.

  5. Hypogonadism and renal failure: An update.

    Science.gov (United States)

    Thirumavalavan, Nannan; Wilken, Nathan A; Ramasamy, Ranjith

    2015-01-01

    The prevalence of both hypogonadism and renal failure is increasing. Hypogonadism in men with renal failure carries with it significant morbidity, including anemia and premature cardiovascular disease. It remains unclear whether testosterone therapy can affect the morbidity and mortality associated with renal failure. As such, in this review, we sought to evaluate the current literature addressing hypogonadism and testosterone replacement, specifically in men with renal failure. The articles chosen for this review were selected by performing a broad search using Pubmed, Embase and Scopus including the terms hypogonadism and renal failure from 1990 to the present. This review is based on both primary sources as well as review articles. Hypogonadism in renal failure has a multifactorial etiology, including co-morbid conditions such as diabetes, hypertension, old age and obesity. Renal failure can lead to decreased luteinizing hormone production and decreased prolactin clearance that could impair testosterone production. Given the increasing prevalence of hypogonadism and the potential morbidity associated with hypogonadism in men with renal failure, careful evaluation of serum testosterone would be valuable. Testosterone replacement therapy should be considered in men with symptomatic hypogonadism and renal failure, and may ameliorate some of the morbidity associated with renal failure. Patients with all stages of renal disease are at an increased risk of hypogonadism that could be associated with significant morbidity. Testosterone replacement therapy may reduce some of the morbidity of renal failure, although it carries risk.

  6. The diagnostic value of contrast-enhanced CT in Acute bilateral renal cortical necrosis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Pil Youb; Lee, Su Han; Lee, Woo Dong [Masan Samsung General Hospital, Seoul (Korea, Republic of)

    1996-11-01

    Acute renal cortical necrosis in which there is destruction of the renal cortex and sparing of the renal medulla, is a relatively rare cause of acute renal failure. A definitive diagnosis of acute renal cortical necrosis is based on renal biopsy, but on CT(computed tomography) the rather specific contrast-enhanced appearance of acute renal cortical necrosis has been described. As renal biopsy is not available, contrast-enhanced CT is a useful, noninvasive investigate modality for the early diagnosis of acute renal cortical necrosis. We report the characteristic CT findings of acute renal cortical necrosis in a patient with acute renal failure following an operation for abdominal trauma.

  7. Modals of Strong Obligation

    Science.gov (United States)

    Matthews-Bresky, R. J. H.

    1977-01-01

    Discusses regularities and peculiarities in the use of the modal verbs of obligation "must,""need" and "should," also of the non-modals "have (got) to" and "need to." Agreements and differences in the use of the verbs are shown, with examples. Use of the various tense-forms is discussed. (IFS/WGA)

  8. Video: Modalities and Methodologies

    Science.gov (United States)

    Hadfield, Mark; Haw, Kaye

    2012-01-01

    In this article, we set out to explore what we describe as the use of video in various modalities. For us, modality is a synthesizing construct that draws together and differentiates between the notion of "video" both as a method and as a methodology. It encompasses the use of the term video as both product and process, and as a data collection…

  9. Clinical application of continuous renal replacement therapy for postoperative renal insufficiency in patient with severe heart valve disease%连续性肾脏替代治疗在重症心脏瓣膜病术后急性肾功能衰竭的临床应用

    Institute of Scientific and Technical Information of China (English)

    王松; 谢凯; 李红; 王琴; 谭君

    2013-01-01

    Objectives To evaluate clinical application the of continuous renal replacement therapy (CRRT) for postoperative renal insufficiency in patient with severe heart valve disease. Methods We retrospectively analyzed the clinical data of 27 patients (live group 15 cases, death group 12 cases) with severe heart valves diseases who got postoperative renal insufficiency and performed CRRT. Results Gender, age, the classification of preoperative heart function classification and extracorporeal circulation time has no significant difference (P<0. 05) between live group and death group. But the duration of AKI before CRRT(P<0. 05)and the time of urine volume<0. 5ml·kg-1·h-1 before CRRT (P<0. 05) in death group were significantly longer than that in live group. The serum creatinine of death group before CRRT is also significantly higher than live group (P<0. 05). The serum creatinine, blood urea nitrogen, mean arterial pressure, central venous blood pressure, K+ and blood HCO3- of all 27 patients after CRRT are statistically significant difference (P<0. 05) with those before CRRT. Conclusion CRRT is an important treatment to these patients with severe heart valve disease who got postoperative renal insufficiency. But the most important problem in this process is the recognition of AKI and early beginning of the therapy. It is suggested that early CRRT therapy is beneficial for reducing mortality rate of these patients.%目的 探讨连续性肾脏替代治疗(CRRT)在心脏瓣膜病术后出现急性肾功能衰竭的临床应用价值.方法 回顾性分析心脏瓣膜病术后合并急性肾功能衰竭行CRRT治疗的27例患者(存活组15例,死亡组12例)的临床资料,并进行统计分析.结果 死亡组CRRT距AKI时间和距尿量<0.5ml/Kg·h时间明显长于存活组(P<0.05),且死亡组CRRT开始前的血肌酐显著高于存活组(P<0.05).27例患者CRRT治疗前后血肌酐、尿素氮、平均动脉压、中心静脉压、血K+、血HCO3

  10. Advances in Modal Logic

    DEFF Research Database (Denmark)

    Modal logic is a subject with ancient roots in the western logical tradition. Up until the last few generations, it was pursued mainly as a branch of philosophy. But in recent years, the subject has taken new directions with connections to topics in computer science and mathematics. This volume i...... epistemic logic, and the logic of evidence.......Modal logic is a subject with ancient roots in the western logical tradition. Up until the last few generations, it was pursued mainly as a branch of philosophy. But in recent years, the subject has taken new directions with connections to topics in computer science and mathematics. This volume...... is the proceedings of the conference of record in its fi eld, Advances in Modal Logic. Its contributions are state-of-the-art papers. The topics include decidability and complexity results for specifi c modal logics, proof theory of modal logic, logics for reasoning about time and space, provability logic, dynamic...

  11. Parametric modal transition systems

    DEFF Research Database (Denmark)

    Beneš, Nikola; Křetínský, Jan; Larsen, Kim Guldstrand;

    2011-01-01

    Modal transition systems (MTS) is a well-studied specification formalism of reactive systems supporting a step-wise refinement methodology. Despite its many advantages, the formalism as well as its currently known extensions are incapable of expressing some practically needed aspects in the refin......Modal transition systems (MTS) is a well-studied specification formalism of reactive systems supporting a step-wise refinement methodology. Despite its many advantages, the formalism as well as its currently known extensions are incapable of expressing some practically needed aspects...... in the refinement process like exclusive, conditional and persistent choices. We introduce a new model called parametric modal transition systems (PMTS) together with a general modal refinement notion that overcome many of the limitations and we investigate the computational complexity of modal refinement checking....

  12. 持续性肾脏替代治疗抗凝技术的应用%The current state and prospect of continuous renal replacement treatment anticoagulation technique

    Institute of Scientific and Technical Information of China (English)

    管向东; 孙冠青; 陈娟

    2012-01-01

    Continuous renal replacement treatment (CRRT) is a common organ function support ive technique in the field of Critical Care Medicine. Since sepsis patients are always combined with hemodynamic instability and coagulation dysfunction , anticoagulation therapy has been an indispensable component part in CRRT for sepsis patients. Anticoagulation therapy enables to slow or reduce the clottings in pipeline and/or filter so as to prolong its life,improve the efficacy of CRRT treatment, and reduce the loss of blood components and thrombosis under pathological state. So far,the common CRRT anticoagulation drugs include heparin,antithrombin,low molecular weight heparin (LMWH) and/or hyparinoids from animal organs, II factor antagonists, nafamostat, sodium citrate and antiplatelet agents. Coagulation function should be regularly monitored in the process of CRRT anticoagulation treatment. Under the circumstance of anticoagulation taboo, heparin-saline priming, predilution and hydrophilic filter can be used to reduce the clottings in pipeline and/or filter.%持续性肾脏替代治疗(CRRT)是重症医学领域常用的器官功能支持技术.由于脓毒症患者常合并血流动力学不稳定及凝血功能障碍,抗凝技术已成为脓毒症患者CRRT过程中必不可少的组成部分.抗凝技术能延缓或减少管路和(或)滤器的凝血,延长其寿命,提高CRRT治疗效率,减少血液成分的丢失及病理状态下的血栓形成.目前常用的CRRT抗凝药物包括肝素、抗凝酶、低分子肝素和(或)肝素类似物、Ⅱ因子拮抗剂、萘莫斯他、枸橼酸钠及抗血小板药物.CRRT抗凝治疗过程中需动态监测凝血功能等指标.在抗凝禁忌的情况下,可用肝素盐水浸泡、前稀释及选择高亲水性滤器等方法减少管路和(或)滤器凝血.

  13. 急性肾损伤患者肾脏替代治疗时机的研究进展%Research advance of the timing of renal replacement therapy among people with acute kidney injury

    Institute of Scientific and Technical Information of China (English)

    郭东晨; 李昂; 段美丽

    2016-01-01

    急性肾损伤(AKI)是重症患者严重的常见合并症之一,是导致患者死亡的独立危险因素。近年来,肾脏替代治疗(RRT)已成为AKI患者常规治疗方法之一,但何时为开始进行RRT的最佳时机国内外尚无一致结论。通过回顾危重症医学及肾脏病学领域学者进行的多项临床研究,总结分析除以往公认的高钾血症、严重代谢性酸中毒、容量过负荷等经典RRT始动因素外的最佳开始治疗时机相关指标,探讨血清肌酐(SCr)、血尿素氮(BUN)、尿量、入重症加强治疗病房(ICU)时间点,以及AKI分期等标准的可行性指标作为RRT最佳始动时机,以期找到特定指标对患者预后意义最大的截点值,为AKI患者进行RRT的最佳时机判断提供指导。%Acute kidney injury (AKI) is one of the most common serious complications in critically ill patients, and it is an independent risk factor for death. In recent years, renal replacement therapy (RRT) has become one of the routine treatments for AKI patients, however there is no accepted consensus on the optimal timing of RRT over the world. This paper reviewed the clinical studies carried out by researchers in the field of critical care and nephrology, thereby summarized and analyzed the related parameters of the optimal time to carry out, with the exception of previously acknowledged classic RRT indications such as hyperkalemia, severe metabolic acidosis, volume overload and so on. The feasible parameters such as serum creatinine (SCr), blood urea nitrogen (BUN), urine volume, the time admitted in the intensive care unit (ICU) and several standards distinguished AKI stages are discussed in order to find out the cutoff points of those parameters which were best for the patients' outcome, and to provide guidance of decision making for the optimal timing of RRT for AKI patients.

  14. From kidney development to drug delivery and tissue engineering strategies in renal regenerative medicine

    NARCIS (Netherlands)

    Dankers, Patricia Y. W.; Boomker, Jasper M.; Meijer, E. W.; Popa, Eliane R.; van Luyn, Marja J. A.

    2011-01-01

    Deterioration of renal function is typically slow but progressive, and therefore renal disease is often diagnosed in a late stage when already serious complaints occur. Ultimately when renal function has dropped below 10%, renal replacement is required. Renal transplantation provides a long-term sol

  15. Acute renal dysfunction in liver diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (MRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation.

  16. Biomarkers in predicting renal replacement therapy in acute septic kidney injury%不同生物学标志物对感染性急性肾损伤肾脏替代治疗的预测作用

    Institute of Scientific and Technical Information of China (English)

    蒋波; 姜利; 席修明

    2013-01-01

    Objective To evaluate whether the serum neutrophil gelatinase associated lipocalin ( sNGAL) , urinary neutrophil gelatinase lipocalin(uNGAL) , urinary interleukin-18 ( uIL-18) or urinary kidney injury molecule-1 ( uKIM-1 ) can predict the need for renal replacement therapy ( RRT) in patients with septic acute kidney injury (AKI). Methods A prospective observational study was conducted in patients with septic AKI whose expected ICU stay ^ 24 h. AKI was defined by American Kidney Injury (AKIN) criteria during the 48 h after admission, while sNGAL, uNGAL, uIL-18 and uKIM-1 were determined at the enrollment. Test characteristics were calculated to assess the diagnostic performance of these biomarkers. Results Forty-five patients were studied, RRT was initiated in 12 patients with septic AKI in the first 7 days. Two groups were defined according to the need of RRT; RRT group(ra=12) and non-RRT group(n=33). RRT group had higher median uNGAL level compared to non-RRT group(912. 0 vs 218. 0 ng/mL, P<0. 001). The predicting performance for uNGAL was good( AUC 0. 88), and that of sNGAL, uIL-18 and uKIM-1 was poor( AUC 0. 68,0. 69,0. 67, respectively). Conclusion uNGAL might be a good biomarker for predicting the need of RRT in patients with septic AKI.%目的 通过测定感染性急性肾损伤患者血清中性粒细胞胶原酶相关脂质运载蛋白(serum neutrophil gelatinase associated lipocalin,sNGAL)、尿中性粒细胞胶原酶相关脂质运载蛋白(urinary neutrophil gelatinase lipocalin,uNGAL)、尿肾损伤因子-1(urinary kidney injury molecule-1,uKIM-1)、尿白细胞介素-18(urinary interleukin-18,uIL-18)浓度,评价上述生物学标志物对感染性急性肾损伤患者接受肾脏替代治疗(renal replacement therapy,RRT)的预测作用.方法 预计入住重症监护病房(intensive care unit,ICU)时间≥24 h的全身性感染患者,并于入组48 h内存在或出现急性肾损伤.测定患者入组时sNGAL、uNGAL、uIL-18、uKIM-1

  17. Coherence for Modalities

    CERN Document Server

    Dosen, K

    2008-01-01

    Positive modalities in systems in the vicinity of S4 and S5 are investigated in terms of categorial proof theory. Coherence and maximality results are demonstrated, and connections with mixed distributive laws and Frobenius algebras are exhibited.

  18. Modalities in medieval logic

    OpenAIRE

    2009-01-01

    This dissertation is an exercise in conceptual archeology. Using the tools of contemporary logic we analyse texts in medieval logic and reconstruct their logical theories by creating a formal framework which models them. Our focus is medieval texts which deal with various modalities: the writings on alethic modalities by William of Sherwood, Pseudo-Aquinas, and St. Thomas Aquinas in the 13th century, St. Anselm of Canterbury’s writings on facere and debere in the late 11th century; Lambert of...

  19. Renal Osteodystrophy

    Directory of Open Access Journals (Sweden)

    Aynur Metin Terzibaşoğlu

    2004-12-01

    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  20. Rol del profesional de Enfermería en terapias de reemplazo renal, diálisis peritoneal / Nursing’s Role in Renal Replacement Therapies, Peritoneal / Dialysis Papel do profissional de Enfermagem em terapias de substituição renal, diálise peritoneal

    OpenAIRE

    Maricel Licht-Ardila, Enf. Esp.; Jennifer Almeida-Arias, Enf.; Fabiola Bolívar-Salazar, Enf.; Yessica Galván-Mármol, Enf.; Silvia García-Trujillo, Enf.

    2014-01-01

    Introducción: La enfermedad renal crónica es considerada un problema de salud pública en el ámbito mundial, debido a su prevalencia e incidencia creciente en la población. El profesional de enfermería asiste al paciente con su patología de base e integra a la familia en la realización de actividades que contribuyen al cuidado y prevención de la enfermedad o a la recuperación de su salud, por lo que el rol principal está orientado a ayudar al paciente, a conservar o lograr su independencia y g...

  1. Toward predicate approaches to modality

    CERN Document Server

    Stern, Johannes

    2016-01-01

    In this volume, the author investigates and argues for, a particular answer to the question: What is the right way to logically analyze modalities from natural language within formal languages? The answer is: by formalizing modal expressions in terms of predicates. But, as in the case of truth, the most intuitive modal principles lead to paradox once the modal notions are conceived as predicates. The book discusses the philosophical interpretation of these modal paradoxes and argues that any satisfactory approach to modality will have to face the paradoxes independently of the grammatical category of the modal notion. By systematizing modal principles with respect to their joint consistency and inconsistency, Stern provides an overview of the options and limitations of the predicate approach to modality that may serve as a useful starting point for future work on predicate approaches to modality. Stern also develops a general strategy for constructing philosophically attractive theories of modal notions conce...

  2. Evidence-based care in patients receiving heterozygous renal replacement therapy after organophosphate poisoning *%杂合肾脏替代治疗救治有机磷中毒患者的循证护理

    Institute of Scientific and Technical Information of China (English)

    彭炜

    2013-01-01

    目的探讨循证护理在使杂合肾脏替代治疗救治有机磷中毒患者中的效果。方法选择2009年1月1日至2012年12月31日重庆医科大学附属第一医院收治的有机磷中毒患者共52例,将其随机均分为常规护理组(采用常规护理模式)、循证护理组(采用循证护理模式)。评价患者精神状态、生活质量、认知能力、累计阿托品用量、胆碱酯酶恢复时间、对护理质量的满意度。结果两组患者入院时一般资料、各项评分资料差异无统计学意义(P>0.05);入院1周后,与常规护理组相比,循证护理组精神状态、生活质量、认知能力均优于常规护理组,差异有统计学意义(P<0.05);循证护理组累计阿托品用量更小、胆碱酯酶恢复时间更快、对护理质量的满意度更高(P<0.05)。结论有机磷中毒患者行杂合肾脏替代治疗时,采用循证护理模式进行护理,可显著改善患者的精神状态、生活质量、自我认知能力,并显著促进患者身体机能的恢复、提升疗效和护理质量。%Objective To investigate the efficacy of evidence-based nursing (EBN) in patients receiving heter-ozygous renal replacement ( HRR) therapy after organophosphate poisoning .Methods 52 patients with organophos-phate poisoning ,treated in this hospital from Jan .1 2009 to Dec .31 2012 ,were randomly divided into control group , receiving routine nursing ,and observation group ,receiving EBN .Mental state ,quality of life ,cognitive ability ,cumu-lative dosage of atropine ,cholinesterase recovery time and degree of satisfaction with the quality of care were evalua -ted .Results General data and score of various evaluation were without difference between the two groups at admis -sion (P> 0 .05) .Compared with control group ,1 week after admission ,state of mind ,quality of life and cognitive a-bilities were better in experiment group (P< 0 .05) .Atropine

  3. The Difference Between Modal Verbs in Deontic and Epistemic Modality

    Directory of Open Access Journals (Sweden)

    Menik Winiharti

    2012-10-01

    Full Text Available Modality is always interesting to discuss. Understanding it is crucial for both language teachers and learners. This essay discusses the concept of modality, its types and uses. It has a goal to find the difference between deontic and epistemic modality that is indicated by their modal verbs. It also provides the readers a better understanding of modality, particularly of its types and uses. The result of the analysis shows that in general, deontic modality indicates obligation and permission, while epistemic modality expresses possibility and prediction. However, the difference between deontic and epistemic modality is not a clear cut, since one single modal verb can express both types, and one single proposition can be expressed by more than one modal verb.  

  4. Renal varices. Diagnosis with CT scan and treatment with embolization; Varices renales. Deagnostic tomodensitometrique et traitement par embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Lenoir, S.; Strauss, Ch.; Fontanelle, L.; Bouzar, N.; Veillon, B.; Vallancien, G.; Palou, R. [Institut Mutualiste Montsouris, 75 - Paris (France)

    1997-09-01

    Two cases of recurrent macroscopic Hematuria in which the diagnosis of left renal vein varices was suggested on CT are described. Bloody efflux was seen from the left ureteric orifice. On CT scans, tubulated contrast-enhanced densities in left perirenal fat were seen. Selective renal angiography was normal. Selective left renal phlebography demonstrated intra and perirenal varices. In the two cases, embolization with metallic coil was successfully performed during left renal phlebography, to stop renal varices flux. Diagnostic and therapeutic modalities of renal varices are discussed with predominant place for CT and phlebography. (authors). 13 refs.

  5. Refinement Modal Logic

    CERN Document Server

    Bozzelli, Laura; French, Tim; Hales, James; Pinchinat, Sophie

    2012-01-01

    In this paper we present refinement modal logic. A refinement is like a bisimulation, except that from the three relational requirements only 'atoms' and 'back' need to be satisfied. Our logic contains a new operator 'forall' in additional to the standard modalities 'Box' for each agent. The operator 'forall' acts as a quantifier over the set of all refinements of a given model. We call it the refinement operator. As a variation on a bisimulation quantifier, it can be seen as a refinement quantifier over a variable not occurring in the formula bound by the operator. The logic combines the simplicity of multi-agent modal logic with some powers of monadic second order quantification. We present a sound and complete axiomatization of multiagent refinement modal logic. We also present an extension of the logic to the modal mu-calculus, and an axiomatization for the single-agent version of this logic. Examples and applications are also discussed: to software verification and design (the set of agents can also be s...

  6. Integration of Multi-Modal Biomedical Data to Predict Cancer Grade and Patient Survival.

    Science.gov (United States)

    Phan, John H; Hoffman, Ryan; Kothari, Sonal; Wu, Po-Yen; Wang, May D

    2016-02-01

    The Big Data era in Biomedical research has resulted in large-cohort data repositories such as The Cancer Genome Atlas (TCGA). These repositories routinely contain hundreds of matched patient samples for genomic, proteomic, imaging, and clinical data modalities, enabling holistic and multi-modal integrative analysis of human disease. Using TCGA renal and ovarian cancer data, we conducted a novel investigation of multi-modal data integration by combining histopathological image and RNA-seq data. We compared the performances of two integrative prediction methods: majority vote and stacked generalization. Results indicate that integration of multiple data modalities improves prediction of cancer grade and outcome. Specifically, stacked generalization, a method that integrates multiple data modalities to produce a single prediction result, outperforms both single-data-modality prediction and majority vote. Moreover, stacked generalization reveals the contribution of each data modality (and specific features within each data modality) to the final prediction result and may provide biological insights to explain prediction performance.

  7. OBSTETRIC RENAL FAILURE

    Directory of Open Access Journals (Sweden)

    Rajeshwari

    2015-11-01

    Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most

  8. A modal nonmonotonic logic

    Institute of Scientific and Technical Information of China (English)

    林作铨

    1996-01-01

    A modal nonmonotonic logic is presented based on an experiential modal semantics on typicality and exception.The syntactic and semantics of modal nonmonotonic logic are provided,and the completeness theorem and the theorems relating it to major nonmonotonic logics are proved.It directly formalizes the intuition of nonmonotonic reasoning.Among other things,it provides us a first-order extension of default logic and autoepistemic logic,and simultaneously has the capability of circumscription to infer universal statement.It has important applications in logic programming and deductive data base.As a result,it provides a uniform basis for various nonmonotonic logics,from which the correspondent relationship among major nonmonotonic logics can coincide.

  9. Dominant modal decomposition method

    Science.gov (United States)

    Dombovari, Zoltan

    2017-03-01

    The paper deals with the automatic decomposition of experimental frequency response functions (FRF's) of mechanical structures. The decomposition of FRF's is based on the Green function representation of free vibratory systems. After the determination of the impulse dynamic subspace, the system matrix is formulated and the poles are calculated directly. By means of the corresponding eigenvectors, the contribution of each element of the impulse dynamic subspace is determined and the sufficient decomposition of the corresponding FRF is carried out. With the presented dominant modal decomposition (DMD) method, the mode shapes, the modal participation vectors and the modal scaling factors are identified using the decomposed FRF's. Analytical example is presented along with experimental case studies taken from machine tool industry.

  10. Renal perfusion scintiscan

    Science.gov (United States)

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  11. [Estrogen replacement].

    Science.gov (United States)

    Søgaard, A J; Berntsen, G K; Magnus, J H; Tollan, A

    1998-02-10

    Recent research on long-term postmenopausal hormone replacement therapy (HRT) indicates a positive effect on both total mortality and morbidity. This has raised the question of widespread preventive long-term use of HRT. Possible side-effects and ideological issues related to preventive HRT have led to debate and uncertainty among health professionals, in the media, and in the population at large. In order to evaluate the level of knowledge about and attitudes towards HRT, a randomly selected group of 737 Norwegian women aged 16-79 was interviewed by the Central Bureau of Statistics. One in three women had received information about HRT in the last two years, mainly through weekly magazines and physicians. The proportion who answered the questions on knowledge correctly varied from 36% to 47%. Those who had been given information by a physician possessed accurate knowledge, had more positive attitudes towards HRT and were more willing to use HRT than women who had reviewed information through other channels. Women with a higher level of education were better informed and more knowledgeable than others, but were nevertheless more reluctant to use HRT than those who were less educated. The limited number of women who actually receive information on HRT, the low level of knowledge and the ambivalent attitudes toward HRT are a major challenge to the public health service.

  12. Teaching German Modal Particles.

    Science.gov (United States)

    Rosler, Dietmar

    1982-01-01

    Believes modern linguistics has done little to explore German modal particles because by focusing on sentences as the basic category for linguistic thinking these words did not seem to matter. Describes model which gives students experience with these particles in meaningful communication. (Author/BK)

  13. Tense, aspect, and modality

    NARCIS (Netherlands)

    Pfau, R.; Steinbach, M.; Woll, B.; Pfau, R.; Steinbach, M.; Woll, B.

    2012-01-01

    Cross-linguistically, the grammatical categories tense, aspect, and modality - when they are overtly expressed - are generally realized by free morphemes (such as adverbials and auxiliaries) or by bound inflectional markers. The discussion in this chapter will make clear that this generalization als

  14. Modalities in medieval logic

    NARCIS (Netherlands)

    Uckelman, S.L.

    2009-01-01

    This dissertation is an exercise in conceptual archeology. Using the tools of contemporary logic we analyse texts in medieval logic and reconstruct their logical theories by creating a formal framework which models them. Our focus is medieval texts which deal with various modalities: the writings on

  15. Renal insufficiency after heart transplantation: a case-control study

    NARCIS (Netherlands)

    T. van Gelder (Teun); R. Zietse (Bob); C.J. Hesse (Cees); W. Weimar (Willem); A.H.M.M. Balk (Aggie); B. Mochtar (Bas)

    1998-01-01

    textabstractBACKGROUND: In Rotterdam 304 heart transplants have been performed since 1984. End-stage renal failure, necessitating renal replacement therapy, has developed in 24 patients (8%) after an interval of 25-121 months (median 79 months). After starting renal rep

  16. Comparison between predilution and postdilution continuous renal replacement therapy (CRRT) for patients with MODS%两种稀释模式肾脏替代治疗MODS患者的效果比较

    Institute of Scientific and Technical Information of China (English)

    谢长江; 刘卫江; 熊旭明

    2011-01-01

    Objective To comparie the effects of pre-dilution with post-dilution continuous renal replacement therapy (CRRT) for patients with MODS. Method Thirty-two MODS patients admitted to ICU (Intensive Care Unit ) were randomized and treated with different modes of CRRT. The results of creatinine clearance, acid-base equilibrium, haemodynamic variables before and post therapy were recorded.The maximal pre-filter pressure, the duration of filter unworn out and mortality of patients treated with different modes of CRRT were also recorded. Results Seventeen patients were treated with pre-dilution mode of CRRT and 15 patients treated with post-dilution mode of CRRT. After 24 hours of pre- and postdilution modes of CRRT, the net increase in Ccr (namely the rate of replacement creatinine clearance) were (15.6±4.6) vs. (22.7 ±4. 1) mL/min respectively (P<0.01); after 48-hour, they were (14.9±3.3)vs. ( 18. 9 ±2. 3) mL/min (p <0. 05) . Both dilution modes could improve the blood PH、 HCO3- and BE( P < 0. 05 ) without significant differences between two groups after CRRT therapy ( P > 0. 05 ) . The MAP of patients treated with pre-dilution modes of CRRT therapy for 24 hours and the MAP of patients before therapy were 69. 2 ± 4. 6 and 56. 7 + 9. 1 mmHg respectively ( P < 0. 05 ), and dosage of dopamine used in patients before CRRT therapy and that after CRRT for 24 hours were ( 11.20 +3.45 ) vs (6. 12 +3.41 ) μg ·kg-1 min -1(P<0.05).The maximal pre-filter pressures of pre-and post-dilution modes were (82.23+9.11) cm H2O, (110.56 +28. 14) cmH2O respectively (P<0.05), and the durations of lasting effect of filter used in two modes of CRRT were ( 39 + 28. 12 ) vs. ( 25 + 14. 45 ) h respectively ( P <0. 05) . Both dilution modes could improve APACHE Scores. There were no significant differences in APACHE Scores and mortalities between two groups after CRRT therapy. Conclusions Post-dilution mode of CRRT has higher filtration rate, but have higher maximal pre

  17. Ultrasonography in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Buturovic-Ponikvar, Jadranka E-mail: jadranka.buturovic@mf.uni-lj.si; Visnar-Perovic, Alenka

    2003-05-01

    Many chronic renal diseases lead to the final common state of decrease in renal size, parenchymal atrophy, sclerosis and fibrosis. The ultrasound image show a smaller kidney, thinning of the parenchyma and its hyperechogenicity (reflecting sclerosis and fibrosis). The frequency of renal cysts increases with the progression of the disease. Ultrasound generally does not allow for the exact diagnosis of an underlying chronic disease (renal biopsy is usually required), but it can help to determine an irreversible disease, assess prognosis and avoid unnecessary diagnostic or therapeutic procedures. The main exception in which the ultrasound image does not show a smaller kidney with parenchymal atrophy is diabetic nephropathy, the leading cause of chronic and end-stage renal failure in developed countries in recent years. In this case, both renal size and parenchymal thickness are preserved until end-stage renal failure. Doppler study of intrarenal vessels can provide additional information about microvascular and parenchymal lesions, which is helpful in deciding for or against therapeutic intervention and timely planning for optimal renal replacement therapy option.

  18. ICU连续性肾替代疗法专业护理小组的建立与实践效果评价%Professional nursing team establishment and implementation effects evaluation of continuous renal replacement therapy in ICU

    Institute of Scientific and Technical Information of China (English)

    葛红梅

    2016-01-01

    目的:观察连续性肾代替疗法对危重病患者的临床治疗效果,探讨ICU连续性肾替代疗法专业护理小组的建立与实践效果评价。方法选取菏泽市立医院2013年10月—2014年10月ICU科内危重患者70例,组建连续性肾替代疗法专业护理小组,发挥专科护理小组的作用,给予危重患者行连续性肾替代疗法以及护理,并与护理小组建立前2012年10月—2013年10月的70例患者的疗效进行比较,观察危重患者治疗前后血钾、血钠、血尿素氮、血尿酸和肌酐含量的变化,测定治疗前后C反应蛋白的含量。结果连续性肾替代疗法可提高ICU抢救危重患者的成功率,140例危重患者死亡38例,5例放弃治疗,病死率为27.14%;与常规护理比较,经连续性肾代替疗法治疗及专业护理小组的综合护理后,危重患者血钾、血钠恢复正常,血尿素氮、血尿酸和肌酐的水平显著下降(P<0.01)。 C反应蛋白含量在治疗后显著下降(P<0.01);专业护理小组的实施,降低了患者并发症的发生,同时提高了ICU连续性肾替代疗法的护理质量。结论连续性肾替代疗法治疗危重患者取得较为理想的效果,且ICU连续性肾替代疗法专业护理小组的成立及良好的运作,可保证连续性肾代替疗法的顺利进行,提高危重患者的抢救成功率。%Objective To observe the clinical effects of continuous renal replacement treatment ( CRRT) in patients with critical illness and to explore the establishment and implementation effects evaluation of CRRT professional care team in ICU. Methods A total of 70 patients with critical illness in ICU were selected from October 2013 to October 2014 in Heze Municipal Hospital. CRRT professional nursing team was established to play an important role in CRRT by providing critical ill patients with CRRT and special nursing. Clinical effects were compared with those in another 70 patients from October 2012 to October 2013

  19. Testosterone Substitution: Current Modalities and Perspectives

    Directory of Open Access Journals (Sweden)

    Zitzmann M

    2006-01-01

    Full Text Available The clinical picture of male hypogonadism is associated with typical symptoms, such as disturbances of mood and cognitive abilities as well as sexual functions; furtheron, a decrease in muscle mass and strength, an accumulation of body fat and osteopenia/osteoporosis are observed. There are indications that insulin sensitivity is mitigated in a state of androgen depletion. In older men, symptoms of androgen deficiency (late-onset hypogonadism may exhibit a differential profile due to accompanying other chronic illnesses. Restoring serum testosterone levels by replacement therapy can markedly attenuate, if not relieve, the clinical picture of hypogonadism. Recently, new treatment modalities have been introduced, which include short-acting transdermal or buccal modalities as well as the long-acting depot preparation of testosterone undecanoate. This review summarises the pathways of diagnosis of male hypogonadism and discusses the various modern methods of initiation and surveillance of testosterone substitution therapy. Future perspectives regarding pharmacogenetic aspects are discussed.

  20. RENAL CRYOABLATION

    Directory of Open Access Journals (Sweden)

    A. V. Govorov

    2012-01-01

    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  1. Renal angiomyolipoma

    DEFF Research Database (Denmark)

    Holm-Nielsen, P; Sørensen, Flemming Brandt

    1988-01-01

    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  2. Das modale Hilfsverb "will" (The Modal Auxiliary Verb "Will")

    Science.gov (United States)

    Kunsmann, Peter W.

    1975-01-01

    That "will" and "shall" are modal, not temporal, verbs is shown by their syntactic similarity to the modals and by the fact that they follow the same transformational rules as the modals. This example demonstrates the usefulness of transformational grammar in explaining grammatical relationships to students. (Text is in…

  3. New Modal Quantum Mechanics

    CERN Document Server

    Hollowood, Timothy J

    2013-01-01

    We describe an interpretation of quantum mechanics based on reduced density matrices of sub-systems from which the standard Copenhagen interpretation emerges as an effective description for macro-systems. The interpretation is a modal one, but does not suffer from the range of problems that plague other modal interpretations. The key feature is that quantum states carry an additional property assignment in the form of one the eigenvectors of the reduced density matrix which evolves evolves according to a stochastic process driven by the unmodified Schrodinger equation, but it is usually hidden from the emergent classical description due to the ergodic nature of its dynamics. However, during a quantum measurement, ergodicity is broken by decoherence and definite outcomes occur with probabilities that agree with the Born rule.

  4. Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease.

    Science.gov (United States)

    Peces, R; Alvarez-Navascués, R

    2001-02-01

    Renal cell carcinoma (RCC) is a disorder encompassing a wide spectrum of pathological renal lesions. Coexistence of unilateral RCC and associated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal failure. So far, data on unilateral RCC with chronic renal failure necessitating renal replacement therapy have not been published. The aim of the present study was to evaluate the incidence of end-stage renal disease (ESRD) from unilateral RCC, and to assess the associated pathology and possible pathogenic factors. In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical information on patients with primary unilateral RCC whilst on their renal replacement programme. Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients underwent radical or partial nephrectomy and were free of recurrence 6--64 months after surgery. Six patients were alive and free of malignancy recurrence for 6--30 months after the onset of haemodialysis. ESRD is rare in association with unilateral RCC, but does contribute to significant morbidity. However, the data presented here are encouraging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.

  5. CYP2D6, GST-M1 and GST-T1 enzymes: expression in parathyroid gland and association with the parathyroid hormone concentration during early renal replacement therapy

    Science.gov (United States)

    Yan, Feng-Xiang; Langub, M Chris; Ihnen, Mark A; Hornung, Carlton; Juronen, Erkki; Rayens, Mary K; Cai, Wei-Min; Wedlund, Peter J; Fanti, Paolo

    2003-01-01

    Aims The purpose of this research was to characterize CYP2D6, GST-M1 and GST-T1 enzyme expression in human parathyroid tissue, and to determine whether or not there is any association between deficiencies in these enzymes and serum parathyroid hormone concentrations in patients with end-stage renal disease. Methods Surgical human parathyroid tissue was obtained and evaluated by immunohistochemistry for cellular localization of CYP2D6, GST-M1 and GST-T1 and colocalization of CYP2D6 with parathyroid hormone. Blood samples were collected from 328 Caucasian patients with end-stage renal disease for genetic testing of CYP2D6*3, *4, *5, *6, *7 and GST-M1*0 and GST-T1*0 alleles. Clinical chemistry data and serum intact parathyroid hormone (iPTH) concentrations were obtained from patient medical records. In 277 of the patients, the same laboratory performed all clinical tests. Results CYP2D6, GST-M1 and GST-T1 were present in human parathyroid tissue. CYP2D6 was colocalized with parathyroid hormone in parathyroid chief cells. Within the end-stage renal disease population, a nonfunctional CYP2D6 genotype was present in 18.2%[95% confidence interval (CI) 8.0, 28.4] of patients in the 1st iPTH concentration quintile (iPTH 347 pg mL−1) (P = 0.001). Out of 12 CYP2D6-deficient females, seven were in the 1st iPTH concentration quintile and the remaining five were in the 5th quintile. Patients deficient in the GST-M1 and GST-T1 enzymes displayed a far more uniform frequency distribution relative to serum iPTH concentrations. Conclusions The presence of CYP2D6, GST-M1 and GST-T1 in parathyroid cells was observed. An association is reported between a lack of CYP2D6 and iPTH concentrations in newly diagnosed end-stage renal disease patients. Gender and concomitant deficiency in GST-M1 and/or GST-T1 appear to define this association further. It remains to be established whether these associations reflect a cause-effect relationship between deficient expression of metabolizing

  6. Preferential reasoning for modal logics

    CSIR Research Space (South Africa)

    Britz, K

    2011-11-01

    Full Text Available Modal logic is the foundation for a versatile and well-established class of knowledge representation formalisms in artificial intelligence. Enriching modal logics with non-monotonic reasoning capabilities such as preferential reasoning as developed...

  7. [Oral cavity pathology by renal failure].

    Science.gov (United States)

    Maĭborodin, I V; Minikeev, I M; Kim, S A; Ragimova, T M

    2014-01-01

    The analysis of the scientific literature devoted to organ and tissue changes of oral cavity at the chronic renal insufficiency (CRI)is made. The number of patients in an end-stage of CRI constantly increases and patients receiving renal replacement therapy including hemodialysis, peritoneal dialysis or renal transplantation will comprise an enlarging segment of the dental patient population. Owing to CRI and its treatment there is a set of changes of teeth and oral cavity fabrics which remain even in a end-stage. Renal replacement therapy can affect periodontal tissues including gingival hyperplasia in immune suppressed renal transplantation patients and increased levels of bacterial contamination, gingival inflammation, formation of calculus, and possible increased prevalence and severity of destructive periodontal diseases. Besides, the presence of undiagnosed periodontitis may have significant effects on the medical management of the patients in end-stage of CRI.

  8. Semantic Structure of English Modals

    Science.gov (United States)

    Cook, Walter A.

    1978-01-01

    English modal verbs constitute a problem for the student of English as a foreign language. This study presents a methodology for a systematic presentation of the meaning of modal verbs. The modals "can,""may,""must," and "have to" are studied. (SW)

  9. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  10. Renal fallure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  11. Renal cancer.

    NARCIS (Netherlands)

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  12. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  13. An application of operational modal analysis in modal filtering

    Energy Technology Data Exchange (ETDEWEB)

    Kurowski, Piotr; Mendrok, Krzysztof; Uhl, Tadeusz, E-mail: mendrok@agh.edu.pl [AGH University of Science and Technology in Krakow, Al. Mickiewicza 30, 30-059, Krakow (Poland)

    2011-07-19

    Modal filtration in the field of damage detection has many advantages, including: its autonomous operation (without the interaction of qualified staff), low computational cost and low sensitivity to changes in external conditions. However, the main drawback of this group of damage detection methods is its limited applicability to operational data. In this paper a method of modal filter formulation from the in-operational data is described. The basis for this approach is FRFs synthesis using knowledge of the operational modal model. For that purpose a method of operational mode shape scaling is described. This is based on the measurements of several FRFs of the object. The method is then applied to the construction of modal filters and modal filtration. Additionally, the study presents verification of the method using data obtained from simulation and laboratory experiments. Verification consisted of comparing the results of modal filtering based on classical experimental modal analysis with the results of the approach proposed in the work.

  14. An application of operational modal analysis in modal filtering

    Science.gov (United States)

    Kurowski, Piotr; Mendrok, Krzysztof; Uhl, Tadeusz

    2011-07-01

    Modal filtration in the field of damage detection has many advantages, including: its autonomous operation (without the interaction of qualified staff), low computational cost and low sensitivity to changes in external conditions. However, the main drawback of this group of damage detection methods is its limited applicability to operational data. In this paper a method of modal filter formulation from the in-operational data is described. The basis for this approach is FRFs synthesis using knowledge of the operational modal model. For that purpose a method of operational mode shape scaling is described. This is based on the measurements of several FRFs of the object. The method is then applied to the construction of modal filters and modal filtration. Additionally, the study presents verification of the method using data obtained from simulation and laboratory experiments. Verification consisted of comparing the results of modal filtering based on classical experimental modal analysis with the results of the approach proposed in the work.

  15. Renal failure in burn patients: a review.

    Science.gov (United States)

    Emara, S S; Alzaylai, A A

    2013-03-31

    Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management.

  16. Malignancy and chronic renal failure.

    Science.gov (United States)

    Peces, Ramon

    2003-01-01

    Increased incidence of cancer at various sites is observed in patients with end-stage renal disease (ESRD). Certain malignant diseases, such as lymphomas and carcinomas of the kidney, prostate, liver and uterus, show an enhanced prevalence compared with the general population. In particular, renal cell carcinoma (RCC) shows an excess incidence in ESRD patients. A multitude of factors, directly or indirectly associated with the renal disease and the treatment regimens, may contribute to the increased tumor formation in these patients. Patients undergoing renal replacement therapy (RRT) are prone to develop acquired cystic kidney disease (ACKD), which may subsequently lead to the development of RCC. In pre-dialysis patients with coexistent renal disease, as in dialysis and transplant patients, the presence of ACKD may predispose to RCC. Previous use of cytotoxic drugs (eg, cyclophosphamide) or a history of analgesic abuse, are additional risk factors for malignancy. Malignancy following renal transplantation is an important medical problem during the follow-up. The most common malignancies are lymphoproliferative disorders (early after transplantation) and skin carcinomas (late after transplantation). Another important confounder for risk of malignancy after renal transplantation is the type of immunosuppression. The type of malignancy is different in various countries and dependent on genetic and environmental factors. Finally, previous cancer treatment in a uremic patient on the transplant waiting list is of great importance in relation to waiting time and post-malignancy screening.

  17. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis?

    Science.gov (United States)

    Ekart, Robert; Hojs, Radovan

    2016-07-01

    Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed.

  18. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD).

    Science.gov (United States)

    Vinsonneau, Christophe; Allain-Launay, Emma; Blayau, Clarisse; Darmon, Michael; Ducheyron, Damien; Gaillot, Theophile; Honore, Patrick M; Javouhey, Etienne; Krummel, Thierry; Lahoche, Annie; Letacon, Serge; Legrand, Matthieu; Monchi, Mehran; Ridel, Christophe; Robert, René; Schortgen, Frederique; Souweine, Bertrand; Vaillant, Patrick; Velly, Lionel; Osman, David; Van Vong, Ly

    2015-12-01

    Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.

  19. Renal teratogens.

    Science.gov (United States)

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O

    2014-09-01

    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  20. Need for Renal Biopsy Registry in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al-Homrany Mohammad

    2008-01-01

    Full Text Available Many renal lesions may result in chronic kidney disease if not detected early or treated properly. Glomerulonephritis is considered one of the leading causes of end-stage renal disease. The prevalence of different renal lesions were identified by inconsistent studies. The causes of inconsistencies include lack of unified methods in diagnosing and processing renal biopsies by different pathologists, patients selection′s bias for renal biopsy, and the variable policies and protocols adopted by different nephrologists. Establishment of renal biopsy registry may help to surmount these differences. In addition, combined data obtained from renal biopsy renal and replacement therapy registries can help study the long-term outcome of patients with renal diseases.

  1. Sarcoidose renal

    Directory of Open Access Journals (Sweden)

    AQUINO MARIA ENEDINA CLAUDINO DE

    2001-01-01

    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  2. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  3. Role of high resolution contrast-enhanced magnetic resonance angiography (HR CeMRA) in management of arterial complications of the renal transplant

    Energy Technology Data Exchange (ETDEWEB)

    Ismaeel, M. Maged [Suez Canal University (Egypt); Abdel-Hamid, Azza, E-mail: azza4951@hotmail.com [Suez Canal University (Egypt)

    2011-08-15

    Introduction: Transplant renal artery (RA) stenosis (TRAS) is the most frequent posttransplantation vascular complication. Contrast enhanced magnetic resonance (CeMRA) angiography has been established as the preferred imaging technique for the evaluation of TRAS because it does not require the use of iodinated contrast material and does not expose the patient to ionizing radiation. Digital subtraction angiography (DSA) is the gold standard in the evaluation of arterial tree of the renal allograft. Aim of the work: This study was carried out to assess the accuracy of CeMRA in the detection of arterial complications after renal transplantation. Patients and methods: Thirty renal transplant patients with suspected arterial complications in which both CeMRA and DSA were performed were included in the study. The HR CeMRA shows 93.7% sensitivity, 80% specificity, 88.2% positive predictive value, 88.9% negative predictive value and 88.5% accuracy. Conclusion: HR CeMRA is an accurate reliable tool in the assessment of arterial complications after renal transplantation. It may replace DSA as a diagnostic modality with reservation of interventional techniques for endovascular treatment of suitable cases.

  4. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  5. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  6. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  7. Renal Hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    İbrahim Halil Bozkurt

    2015-03-01

    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  8. Cognitive Dysfunction in Chronic Renal Disease: Impact of Dialysis Modality

    Directory of Open Access Journals (Sweden)

    Recep AK

    2015-12-01

    Full Text Available OBJECTIVE: Cognitive dysfunction (CD is common among patients with chronic kidney disease (CKD and contributes to morbidity and mortality. We aimed to explore the factors involved in the development of CD in patients with CKD and to compare cognitive function between hemodialysis (HD and peritoneal dialysis (PD patients. MATERIAL and METHODS: We studied 122 patients with different stages of CKD, and divided them into two groups: Predialysis Group: included 60 CKD patients, (28 stage III and 34 stage IV; Dialysis Group: included 60 patients on dialysis therapy, (30 on HD and 30 on PD. Psychometric tests were done all patients. The results were compared with 41 healthy subjects. RESULTS: We found that the CD rate was higher in patients with CKD (24.6% than controls (0%, p<0.001. The Mini Mental Test score was found to be correlated with age (r=-0.428, hemoglobin (r=0.336, CRP (r=-0.311, and albumin (r=0.336; the Calculation Test score was found to be correlated with LDL cholesterol (r=-0.336; the Praxis Test Score was found to be correlated with duration of CKD (r=-0.204, HDL (r=0.188; and the Visual Memory Test score was found to be correlated with parathormone levels (r=-0.270. We found the CD rate to be higher in patients on HD (50% than on PD (23.3%, p=0.032. CONCLUSION: Our findings suggest that anemia, malnutrition and inflammation play an important role in the development of CD in our patients, and cognitive functions are better preserved in the PD group than the HD group.

  9. [Vitamin D treatment and renal osteodystrophy: indications and modalities].

    Science.gov (United States)

    Fournier, A; Morinière, P; Yverneau-Hardy, P; Westeel, P F; Mazouz, H; el Esper, N; Ghazali, A; Boudailliez, B

    1995-01-01

    1. 1 alpha (OH) vitamin D3 derivatives have an inconstant long term inhibitory effect on PTH secretion. As a matter of fact they act by three mechanisms, one of these being antagonistic: 1) a direct inhibitory action on the prepro-PTH gene; 2) an indirect inhibitory action by increasing plasma calcium; 3) an indirect stimulatory action by increasing plasma phosphate. These two latter phenomena are due to the stimulation of the intestinal absorption of these ions as well as to an intrinsic osteolytic action which may override the inhibition of the bone release of these ions in relation with the decrease of the PTH plasma levels. 2. The use of 1 alpha (OH)D3 derivatives in patients on chronic dialysis is justified in about 30% of the patients on dialysis when in spite of native vitamin D repletion and adequate predialysis control of plasma calcium (2.5 +/- 2 mmol/l) and of plasma phosphate (1.4 - 1.7 mmol/l), the PTH plasma levels are 3 or 5 fold the upper limit of normal whether the patient is on hemodialysis or on CAPD. When hyperphosphatemia is > 1.7 mmol/l it is first necessary to correct it by the use of higher doses of alkaline calcium salts given with the meals as phosphate binder together with a negative perdialytic calcium balance induced by a lower dialysate calcium in order to avoid hypercalcemia. Control of hyperphosphatemia is indeed a necessary prerequisite for the long term PTH suppressive efficacy of 1 alpha OH vitamin D derivatives. 3. The use of 1 alpha(OH)D3 derivatives in the treatment of the predialysis uremic patients is even more limited because there is no additional mean to decrease the risk of hypercalcemia when oral calcium is used as phosphate binder because of the danger of aluminum and magnesium phosphate binders. Fortunately in the adult, oral calcium used as phosphate binder in association with phosphate restriction and correction of possible vitamin D depletion and acidosis is usually efficace to control hyperparathyroïdism without 1 alpha OH vitamin D3. This is not the case in the child to whom protein and phosphate restriction should not be prescribed because of its incompatibility with the Recommended Diet Allowance. Fortunately the high remodeling rate of his growing bones, decreases the risk of hypercalcemia due to the combination of CaCO3 and 1 alpha OH vitamin D3.

  10. Modal aerosol dynamics modeling

    Energy Technology Data Exchange (ETDEWEB)

    Whitby, E.R.; McMurry, P.H.; Shankar, U.; Binkowski, F.S.

    1991-02-01

    The report presents the governing equations for representing aerosol dynamics, based on several different representations of the aerosol size distribution. Analytical and numerical solution techniques for these governing equations are also reviewed. Described in detail is a computationally efficient numerical technique for simulating aerosol behavior in systems undergoing simultaneous heat transfer, fluid flow, and mass transfer in and between the gas and condensed phases. The technique belongs to a general class of models known as modal aerosol dynamics (MAD) models. These models solve for the temporal and spatial evolution of the particle size distribution function. Computational efficiency is achieved by representing the complete aerosol population as a sum of additive overlapping populations (modes), and solving for the time rate of change of integral moments of each mode. Applications of MAD models for simulating aerosol dynamics in continuous stirred tank aerosol reactors and flow aerosol reactors are provided. For the application to flow aerosol reactors, the discussion is developed in terms of considerations for merging a MAD model with the SIMPLER routine described by Patankar (1980). Considerations for incorporating a MAD model into the U.S. Environmental Protection Agency's Regional Particulate Model are also described. Numerical and analytical techniques for evaluating the size-space integrals of the modal dynamics equations (MDEs) are described. For multimodal logonormal distributions, an analytical expression for the coagulation integrals of the MDEs, applicable for all size regimes, is derived, and is within 20% of accurate numerical evaluation of the same moment coagulation integrals. A computationally efficient integration technique, based on Gauss-Hermite numerical integration, is also derived.

  11. No Can Do Modal Verbs

    Directory of Open Access Journals (Sweden)

    Gašper Ilc

    2008-06-01

    Full Text Available The paper presents the systems of modal verbs in Slovene and English, and it focuses on comprehension and usage problems that advanced students of English may have when dealing with modal verb constructions. The paper identifies the key factors that give rise to various problems, such as in-vacuo vs. in-context treatment of modal verbs and absolute vs. relative temporal relations. It is argued that most students fail to fully understand contextualised modal verb constructions mostly due to the polysemy of modal verbs as well as their relative tense value. This is particularly the case when a (narrative text containing modal verb constructions has a past time reference, and combines different narrative techniques.

  12. Série histórica de custos com terapia de substituição renal no município do Rio de Janeiro (1995-2009) Serie histórica de costes con terapia de reemplazo renal en la ciudad de Rio de Janeiro (1995-2009) Time series of costs of renal replacement therapy in Rio de Janeiro city (1995-2009)

    OpenAIRE

    Genesis de Souza Barbosa; Raphael Mendonça Guimarães; Marluci Andrade Conceição Stipp

    2013-01-01

    Objetivou-se avaliar a tendência temporal do custo total de terapia de substituição renal e a proporção entre custo e solicitações de Autorizações de Procedimentos Ambulatoriais de Alta Complexidade/Custo no município do Rio de Janeiro, entre 1995 e 2009, em totais e segundo prestador. Estudo quantitativo, descritivo, tipo série temporal. Utilizaram-se informações referentes aos valores e quantidades de autorizações de procedimentos de alta complexidade para terapia de substituição renal por ...

  13. On Modal Refinement and Consistency

    DEFF Research Database (Denmark)

    Nyman, Ulrik; Larsen, Kim Guldstrand; Wasowski, Andrzej

    2007-01-01

    Almost 20 years after the original conception, we revisit several fundamental question about modal transition systems. First, we demonstrate the incompleteness of the standard modal refinement using a counterexample due to Hüttel. Deciding any refinement, complete with respect to the standard...... notions of implementation, is shown to be computationally hard (co-NP hard). Second, we consider four forms of consistency (existence of implementations) for modal specifications. We characterize each operationally, giving algorithms for deciding, and for synthesizing implementations, together...

  14. Load Estimation from Modal Parameters

    DEFF Research Database (Denmark)

    Aenlle, Manuel López; Brincker, Rune; Fernández, Pelayo Fernández;

    2007-01-01

    In Natural Input Modal Analysis the modal parameters are estimated just from the responses while the loading is not recorded. However, engineers are sometimes interested in knowing some features of the loading acting on a structure. In this paper, a procedure to determine the loading from a FRF...... matrix assembled from modal parameters and the experimental responses recorded using standard sensors, is presented. The method implies the inversion of the FRF which, in general, is not full rank matrix due to the truncation of the modal space. Furthermore, some ecommendations are included to improve...

  15. End-stage renal disease in the El-Minia Governorate, upper Egypt: An epidemiological study

    Directory of Open Access Journals (Sweden)

    Osama El Minshawy

    2011-01-01

    Full Text Available We had earlier conducted two cross-sectional studies on the epidemiology of endstage renal disease (ESRD in the El-Minia Governorate. The aim of this study is to assess the prevalence, etiology and risk factors for ESRD in the El-Minia Governorate during the year 2006. Patients on renal replacement therapy (RRT, numbering 1356, were recruited into this study. A standardized questionnaire was completed including demographics, family history, risk factors for ESRD, environmental exposure to toxins, work conditions, social history and causes of death. Only 800 (59% of the 1356 patients agreed to participate in this study. Their mean age was 46 ± 13 years, median 43 (range 18-80. The male vs. female ratio was 65% vs. 35%. The etiology of ESRD was unknown in 27%, hypertension in 20%, chronic glomerulonephritis in 11%, obstructive uropathy in 12%, bilhaziasis in 3%, analgesic nephropathy in 5%, chronic pyelonephritis in 5%, diabetic nephropathy in 8% and others, e.g. lupus in 9%. The overall prevalence of ESRD was 308 per million population (pmp. The modalities of RRT used on the study patients included hemodialysis (HD in 1315 (97%, peritoneal dialysis (PD in 27 (2% and renal transplantation in 14 patients (1%. The death rate was 190/1000. Our study suggests that the epidemiology of ESRD in the El-Minia Governorate is different from that in European countries and the US and thus, region-specific interventions must be developed to control the epidemic of ESRD in the world.

  16. Metaphysical Modality, Modality of Predicate and the Theory of

    Directory of Open Access Journals (Sweden)

    l nabavi

    2010-05-01

    This paper discusses the historical overview of the metaphysical modality firstly and then shows that the theory of "Decisive Necessity” is true and justified in a model of modal logic with equivalent accessibility relation and homogeneous possible world view (fixed domain.

  17. Interventional radiological treatment of renal transplant complications: A pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Lezzi, Roberto; La, Torre Michele fabio; Santoro, Marco; Dattesi, Robrta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; CItterio, Franco; Bonomo, Lorenzo [' A. Gemelli' Hospital - Catholic University, Rome (Italy)

    2015-06-15

    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management.

  18. A Modal Walk Through Space

    NARCIS (Netherlands)

    Aiello, Marco; Benthem, Johan van

    2002-01-01

    We investigate the major mathematical theories of space from a modal standpoint: topology, affine geometry, metric geometry, and vector algebra. This allows us to see new fine-structure in spatial patterns which suggests analogies across these mathematical theories in terms of modal, temporal, and c

  19. Modal Logics for Cryptographic Processes

    DEFF Research Database (Denmark)

    Frendrup, U.; Huttel, Hans; Jensen, N. J.

    2002-01-01

    We present three modal logics for the spi-calculus and show that they capture strong versions of the environment sensitive bisimulation introduced by Boreale et al. Our logics differ from conventional modal logics for process calculi in that they allow us to describe the knowledge of an attacker ...

  20. Constraint methods for modal satisfiability

    NARCIS (Netherlands)

    Brand, S.; Gennari, R.; de Rijke, M.; Apt, K.R.; Fages, F.; Rossi, F.

    2004-01-01

    Modal and modal-like formalisms such as temporal or description logics go beyond propositional logic by introducing operators that allow for a guarded form of quantication over states or paths of transition systems. Thus, they are more expressive than propositional logic, yet computationally better

  1. Modal abstractions of concurrent behavior

    DEFF Research Database (Denmark)

    Nielson, Flemming; Nanz, Sebastian; Nielson, Hanne Riis

    2011-01-01

    We present an effective algorithm for the automatic construction of finite modal transition systems as abstractions of potentially infinite concurrent processes. Modal transition systems are recognized as valuable abstractions for model checking because they allow for the validation as well as re...

  2. 连续性肾脏替代治疗毒蛇咬伤致多器官功能障碍的临床研究%The clinical study of the continuous renal replacement therapy on multiple organ dysfunction syndrome caused by venomous snake bite

    Institute of Scientific and Technical Information of China (English)

    廖汪洋; 刘琼

    2011-01-01

    Objective To investigate the effect of continuous renal replacement therapy(CRRT) in patients with multiple organ disorder syndrome(MODS) caused by venomous snake bite. Methods 83 cases of MODS caused by venomous snake bite were divided into CRRT treatment group and non CRRT treatment group. Plasma levels of IL-1 , IL-6 , and TNF-α were detected by enzyme linked immunosorbent assay (KLISA) before and after CRRT, and the outcomes of blood gas analysis, level of electrolytes, renal function and liver function were also detected. Results Plasma levels of TNF-α, IL-1, IL-6 were significantly decreased in CRRT treatment group compared with the baseline values before CRRT (P0.05),两组治疗后血清炎症因子水平比较差异有统计学意义(P<0.05);CRRT治疗组治疗后血气分析、血电解质水平及肝、肾功能较非CRRT治疗组有明显改善(P<0.05),总体治愈率也明显高于非CRRT治疗组,两组比较差异有统计学意义(P<0.05).结论 毒蛇咬伤致MODS患者及时行CRRT治疗对清除炎症因子,纠正水、电解质和酸碱平衡紊乱,改善肝肾功能效果明显,对改善MODS患者预后有显著作用.

  3. 持续肾脏替代治疗侵袭性NK/T细胞淋巴瘤并发急性肿瘤溶解综合征1例并文献复习%Continuous renal replacement therapy on acute tumor lysis syndrome in an aggressive NK/T cell lymphoma:A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    陈芯仪; 吴俣

    2013-01-01

    Objective:To improve the recognition of acute tumor lysis syndrome (ATLS) and to explore the role of continuous renal replacement therapy (CRRT) in its emergency.Method:A case of ATLS in an aggressive NK/T cell lymphoma was emergently cured by CRRT.Result:After CRRT,the patient with heart failure symptoms quickly eased,urine output increased,potassium and metabolic acidosis were corrected promptly,and renal function improved quickly.Conclusion:ATLS patients should be considered early CRRT if efficacy of drugs is poor.In ATLS patients of unstable hemodynamics and intolerance for routine hemodialysis,CRRT should be a superior option.%目的:提高对急性肿瘤溶解综合征(ATLS)的认识和探讨持续肾脏替代治疗(CRRT)在其急救中的作用.方法:对1例侵袭性NK/T细胞淋巴瘤化疗后并发ATLS患者,采用CRRT救治.结果:通过CRRT,患者心力衰竭症状很快得到缓解,尿量增多,高钾、代谢性酸中毒及时得到纠正,肾功能也很快得到改善,疗效显著.结论:对于ATLS患者,如果药物疗效欠佳,应及早考虑CRRT;如果患者血流动力学不稳定,不能耐受普通血液透析治疗,CRRT应成为优先考虑的治疗选择.

  4. Renal relevant radiology: renal functional magnetic resonance imaging.

    Science.gov (United States)

    Ebrahimi, Behzad; Textor, Stephen C; Lerman, Lilach O

    2014-02-01

    Because of its noninvasive nature and provision of quantitative measures of a wide variety of physiologic parameters, functional magnetic resonance imaging (MRI) shows great potential for research and clinical applications. Over the past decade, application of functional MRI extended beyond detection of cerebral activity, and techniques for abdominal functional MRI evolved. Assessment of renal perfusion, glomerular filtration, interstitial diffusion, and parenchymal oxygenation turned this modality into an essential research and potentially diagnostic tool. Variations in many renal physiologic markers can be detected using functional MRI before morphologic changes become evident in anatomic magnetic resonance images. Moreover, the framework of functional MRI opened a window of opportunity to develop novel pathophysiologic markers. This article reviews applications of some well validated functional MRI techniques, including perfusion, diffusion-weighted imaging, and blood oxygen level-dependent MRI, as well as some emerging new techniques such as magnetic resonance elastography, which might evolve into clinically useful tools.

  5. Shoulder Joint Replacement

    Science.gov (United States)

    ... Shoulder Replacement Options Shoulder replacement surgery is highly technical. It should be performed by a surgical team ... area and will meet a doctor from the anesthesia department. You, your anesthesiologist, and your surgeon will ...

  6. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  7. Therapeutic Effect Analysis of Continuous Renal Replacement Therapy in 90 Cases of Multiple Organ Dysfunction Syndrome%连续性肾脏替代疗法治疗多脏器功能障碍综合征90例疗效分析

    Institute of Scientific and Technical Information of China (English)

    王少清; 汪力; 秦花; 黄艾晶

    2012-01-01

    Objective To study the clinical therapeutic effects of continuous renal replacement therapy ( CRRT) in multipal organ dysfunction syndrom( MODS ). Methods 90 MODS patients accepted therapy of CRRT in our hospital from Jan. 2009 to Jun 2010. Their APACHE Ⅱ , vital signs, such as blood pressure, heart rate,arterial blood gas analysis,and renal function,blood electrolyte were observed during course of CRRT. Results After CRRT treatment, vital signs of all patients were stable. The APACHE Ⅱ of patients were obviously declined. The laboratory test results, such as BLN , SCr, blood electrolyte and pll were significantly improved. Compared with the situation before treatment, there was significant difference( All P <0. 05 ). Conclusion Application of CRRT in patients with MODS can be effective in improving renal function, regulating acid-base imbalance, electrolyte disorders and prognosis of patients.%目的 探讨连续性肾脏替代疗法(CRRT)治疗多脏器功能障碍综合征(MODS)的临床疗效.方法 选取2009年1月至2010年6月接受CRRT治疗的MODS患者90例,观察治疗前后患者急性生理学和慢性健康评估(APACHEⅡ)评分、生命体征(血压、心率、血氧饱和度)以及电解质、肾功能情况.结果 与治疗前比较,全部患者治疗后APACHEⅡ明显下降,差异有统计学意义(P<0.05).治疗后患者生命体征稳定,各个指标与治疗前比较差异有统计学意义(P<0.05).与治疗前比较,所有患者治疗后血肌酐、尿素氮、电解质、pH值均得到较好控制,差异有统计学意义(P<0.05).结论 应用CRRT治疗MODS患者可有效改善肾功能,调节酸碱失衡、电解质紊乱,有利于改善患者的预后.

  8. Interpreting Metaphor of Modality in Advertising English

    Science.gov (United States)

    Xu, Jian

    2009-01-01

    Based on a review of the historical and current studies on modality, this paper aims at interpreting metaphor of modality and its functions in advertising English according to theories of modality system and metaphor of modality in systemic-functional linguistics with a corpus we have collected. It is pointed out that metaphor of modality, a usual…

  9. Renal Cysts

    Science.gov (United States)

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  10. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  11. Drug-induced renal injury

    African Journals Online (AJOL)

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  12. The clinical data used for conventional indications of initiating renal replacement therapy and for predicting the prognosis of critically ill patients with acute kidney injury%传统肾脏替代治疗开始指标在判断重症急性肾损伤患者预后的价值

    Institute of Scientific and Technical Information of China (English)

    陈敏华; 孙仁华; 李茜

    2016-01-01

    Objective To investigate the value of clinical data used for conventional indications of initiating renal replacement therapy (RRT) such as serum creatinine (SCr),blood urea nitrogen (BUN) and acute renal injury (AKI) stage and in estimating the prognosis of critically ill patients with AKI.Methods A retrospective analysis of 258 AKI adult inpatients treated with continuous renal replacement therapy (CRRT) in ICU from Jan.2011 to Jan.2015.According to the outcomes,all subjects were divided into survival group (n =104)and death group (n =154).The general condition,AKI causes,results of renal function (urine output,SCr,BUN and AKI stage),homeostasis (acid-base balance and electrolyte level),severity of disease (APACHE Ⅱ score and SOFA score) and others were compared between two groups.Additionally,risk factors for the prognosis of critically ill patients with AKI were screened by the multivariate Cox's proportional hazard models and the receiver operating characteristic (ROC) curve.Results There were no significant differences in gender,age,primary disease,AKI causes,APACHE Ⅱ score,renal function (urine output,SCr,BUN and AKI stage),serum potassium level and phosphorus level between two groups before CRRT (P > 0.05),but more patients in death group had severe sepsis (31.17% vs.19.23%,P =0.033),lower pH value [(7.27 ±0.34)vs.(7.41 ±0.34),P =0.024] and higher level of lactate [(3.97 ±2.87) vs.s (2.64 ± 2.30),P =0.006].After the analysis with multivariate Coxg proportional hazard models,it was found that the levels of serum phosphorus (P =0.043) and lactate (P =0.009) were the independent risk factors for prognosis of critically ill patients with AKI,and other conventional indications for initiating RRT such as SCr,BUN,AKI stage,urine output,pH,bicarbonate level or potassium level were not closely associated with the prognosis of patients (P > 0.05).Therefore,a composite of these six variables (pH,bicarbonate level,phosphorus level,potassium level

  13. Modal abstractions of concurrent behavior

    DEFF Research Database (Denmark)

    Nielson, Flemming; Nanz, Sebastian; Nielson, Hanne Riis

    2011-01-01

    We present an effective algorithm for the automatic construction of finite modal transition systems as abstractions of potentially infinite concurrent processes. Modal transition systems are recognized as valuable abstractions for model checking because they allow for the validation as well...... as refutation of safety and liveness properties. However, the algorithmic construction of finite abstractions from potentially infinite concurrent processes is a missing link that prevents their more widespread usage for model checking of concurrent systems. Our algorithm is a worklist algorithm using concepts...

  14. Sorbents in acute renal failure and end-stage renal disease: middle molecule and cytokine removal.

    Science.gov (United States)

    Winchester, James F; Silberzweig, Jeffrey; Ronco, Claudio; Kuntsevich, Viktoria; Levine, Daniel; Parker, Tom; Kellum, John A; Salsberg, Jamie A; Quartararo, Peter; Levin, Nathan W

    2004-01-01

    Renal replacement therapy in acute renal failure (ARF) and chronic renal failure (end-stage renal disease; ESRD) has been based on the use of modifications of dialysis (continuous arteriovenous hemofiltration and hemodiafiltration) to remove middle-molecular-weight toxins, consisting of low-molecular-weight proteins and peptides (LMWP) and cytokines involved in inflammation. High-flux dialyzers are not efficient at removing LMWP, and for this reason, sorbents have been studied to augment or replace dialysis. Removal of LMWP such as beta2-microglobulin, leptin, complement factor D, angiogenin and cytokines such as interleukin (IL)-1, IL-6, IL-10, IL-18 and tumor necrosis factor-alpha has been established in animal models of sepsis and in ESRD patients using sorbents. Sorbent devices added to hemodialysis, or the use of such devices alone in inflammatory states, including sepsis, ARF, cardiopulmonary bypass, pre-explantation of donor organs and ESRD, are being studied.

  15. Renale Osteopathie

    OpenAIRE

    Horn S

    2001-01-01

    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  16. Renale Knochenerkrankungen

    Directory of Open Access Journals (Sweden)

    Mayer G

    2008-01-01

    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  17. Whole-body MRI in follow-up of patients with renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan; Zastrow, Stefan; Deppe, Pierre-Emanuel; Laniado, Michael; Stroszczynski, Christian (Dept. of Radiology, Dresden Univ. of Technology, Dresden (Germany)), e-mail: ivan.platzek@uniklinikum-dresden.de; Grimm, Marc-Oliver; Wirth, Manfred (Dept. of Urology, Dresden Univ. of Technology, Dresden (Germany))

    2010-06-15

    Background: Recent technological advances have made whole-body MRI feasible within a reasonable time-frame. The clinical utility of whole-body MRI in patients with renal cell carcinoma has not been evaluated yet. Purpose: To compare the diagnostic accuracy of whole-body MRI and computed tomography (CT) in follow-up of patients with renal cell carcinoma. Material and Methods: In 28 patients with primary renal cell carcinoma a multislice CT scan of the thorax, abdomen, and pelvis, and a whole-body MRI were carried out as part of the postoperative follow-up. A combination of subsequent imaging studies and histology served as standard of reference. Results: MRI demonstrated a significantly better diagnostic accuracy regarding musculoskeletal metastases compared with CT (97.7% vs 82%, P<0.001). In contrast, CT was superior in the detection of pulmonary metastases (88.5% vs 71.9%, P<0.001). Both methods had similar diagnostic performance regarding lymph node metastases (CT, accuracy 82.4%; MRI, accuracy 83.4%, P=0.25). The concordance of both modalities regarding N and M stage was excellent (Cohen's kappa 1.00). In two patients cerebral metastases were revealed by MRI, which led to a change in therapy. Conclusion: At this stage, whole-body MRI cannot be considered an adequate replacement for CT in the follow-up of patients with renal cell carcinoma. Further significant improvement of lung MR protocols is necessary, as CT's sensitivity for pulmonary nodules is clearly superior. In contrast, the main advantage of whole-body MRI is its high diagnostic accuracy for musculoskeletal metastases

  18. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  19. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  20. Spectrum of pediatric renal diseases in dubai.

    Science.gov (United States)

    Abou-Chaaban, M; Al Murbatty, B; Majid, M A

    1997-01-01

    A total of 712 patients with renal problems, aged 13 years or below (mean age 4.12 years) were seen in the Department of Health and Medical Services Hospitals in Dubai in the period from 1991 to 1996. The male to female ratio was 1:1.1. UAE citizens constituted 32% of the total, with a male to female ratio of 1:1.2. Nephrotic syndrome (26.3%) had the highest prevalence among the renal diseases seen, followed by urinary tract infection (19.1%), glomerulonephritis (GN) (9.7%), congenital renal anomalies (9.7%), and chronic renal failure (CRF) (7%). Congenital renal anomalies were the main cause of CRF in our patients followed by GN. Acute renal failure (ARF) occurred in 1.4% of the patients and was not an alarming problem; it had an uncomplicated course and good prognosis. Continuous ambulatory peritoneal dialysis was the mode of replacement therapy for patients with end-stage renal disease. Eight patients underwent renal transplantation; one cadaver donor, four living non-related donor (abroad) and three living related donor.

  1. Letter Position Coding Across Modalities: The Case of Braille Readers

    Science.gov (United States)

    Perea, Manuel; García-Chamorro, Cristina; Martín-Suesta, Miguel; Gómez, Pablo

    2012-01-01

    Background The question of how the brain encodes letter position in written words has attracted increasing attention in recent years. A number of models have recently been proposed to accommodate the fact that transposed-letter stimuli like jugde or caniso are perceptually very close to their base words. Methodology Here we examined how letter position coding is attained in the tactile modality via Braille reading. The idea is that Braille word recognition may provide more serial processing than the visual modality, and this may produce differences in the input coding schemes employed to encode letters in written words. To that end, we conducted a lexical decision experiment with adult Braille readers in which the pseudowords were created by transposing/replacing two letters. Principal Findings We found a word-frequency effect for words. In addition, unlike parallel experiments in the visual modality, we failed to find any clear signs of transposed-letter confusability effects. This dissociation highlights the differences between modalities. Conclusions The present data argue against models of letter position coding that assume that transposed-letter effects (in the visual modality) occur at a relatively late, abstract locus. PMID:23071522

  2. Letter position coding across modalities: the case of Braille readers.

    Directory of Open Access Journals (Sweden)

    Manuel Perea

    Full Text Available BACKGROUND: The question of how the brain encodes letter position in written words has attracted increasing attention in recent years. A number of models have recently been proposed to accommodate the fact that transposed-letter stimuli like jugde or caniso are perceptually very close to their base words. METHODOLOGY: Here we examined how letter position coding is attained in the tactile modality via Braille reading. The idea is that Braille word recognition may provide more serial processing than the visual modality, and this may produce differences in the input coding schemes employed to encode letters in written words. To that end, we conducted a lexical decision experiment with adult Braille readers in which the pseudowords were created by transposing/replacing two letters. PRINCIPAL FINDINGS: We found a word-frequency effect for words. In addition, unlike parallel experiments in the visual modality, we failed to find any clear signs of transposed-letter confusability effects. This dissociation highlights the differences between modalities. CONCLUSIONS: The present data argue against models of letter position coding that assume that transposed-letter effects (in the visual modality occur at a relatively late, abstract locus.

  3. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Grattan-Smith, J.D. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Jones, Richard A. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)

    2008-01-15

    MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

  4. RENAL ALLOGENEIC TRANSPLANTATION IN PATIENT WITH HAEMOPHILIA B

    Directory of Open Access Journals (Sweden)

    N. V. Purlo

    2014-01-01

    Full Text Available We report the case of successful renal allogeneic transplantation and treatment in a 56-year-old patient with haemophilia B at Hematology Research Center. He has received replacement therapy by factor IX since 2010. The transplant is marked with good renal function during 13 post-transplant months without episodes of rejection or bleeding complications. The complicated surgical interventions are possible in patients with haemophilia В аnd end-stage chronic renal failure in the presence of replacement therapy of IX factor for the purpose of achievement of optimum hemostasis.

  5. Impact of magnetic resonance urography on preoperative diagnostic workup in children affected by hydronephrosis: should IVU be replaced?

    Science.gov (United States)

    Leppert, A; Nadalin, S; Schirg, E; Petersen, C; Kardorff, R; Galanski, M; Fuchs, J

    2002-10-01

    The aim of this study was to determine the role of magnetic resonance urography (MRU) in preoperative diagnostic workup of children with hydronephrosis in a prospective clinical study with comparison of MRU, standard diagnostic investigations, and intraoperative findings. Thirty-one children with hydronephrosis secondary to different causes underwent ultrasound scan (US), intravenous urography (IVU), micturation cysto-urethrography (MCU), isotope nephrography (ING) and MRU. For MRU the authors performed sagittal and coronal halve-Fourier SSFSE scans in a 1.5 Tesla MR system. T1- and T2-weighted sequences were used in axial orientation to improve morphologic information. In 24 patients, preoperative data were compared with intraoperative findings. Comparison of the different imaging modalities proved MRU to be able to provide more detailed information about the correct localization of stenoses along the urinary tract and the morphology of renal parenchyma. MRU showed the highest concordance of all imaging modalities with intraoperative findings. As a reliable investigation, MRU has the potentials to replace IVU in preoperative diagnostic workup of hydronephrosis in childhood. Copyright 2002, Elsevier Science (USA). All rights reserved.

  6. Aeronautical Information System Replacement -

    Data.gov (United States)

    Department of Transportation — Aeronautical Information System Replacement is a web-enabled, automation means for the collection and distribution of Service B messages, weather information, flight...

  7. Disparities in renal care in Jalisco, Mexico.

    Science.gov (United States)

    Garcia-Garcia, Guillermo; Renoirte-Lopez, Karina; Marquez-Magaña, Isela

    2010-01-01

    End-stage renal disease represents a serious public health problem in Mexico. Close to 9% of the Mexican population has chronic kidney disease (CKD) and 40,000 patients are on dialysis. However, the fragmentation of our health care system has resulted in unequal access to renal replacement therapy. In addition, poor patients in Jalisco with kidney failure have very advanced disease at the time of dialysis initiation, suggesting lack of access to predialysis care. To address these issues, a number of strategies have been implemented. Among them a renal replacement therapy program for which the cost of treatment is shared by government, patients, industry, and charitable organizations; the implementation of a state-funded hemodialysis program that provides free dialysis for the poor; the establishment of a university-sponsored residency program in nephrology and a postgraduate training in nephrology nursing; and a screening program for early detection and control of CKD. In conclusion, access to renal care is unequal. The extension of the Seguro Popular to cover end-stage renal disease treatment nationwide and the implementation of community screening programs for the detection and control of CKD offers an opportunity to correct the existing disparities in renal care in Jalisco and perhaps in other regions of Mexico.

  8. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ozlem Tiryaki

    2013-01-01

    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  9. Multi-Modality Phantom Development

    Energy Technology Data Exchange (ETDEWEB)

    Huber, Jennifer S.; Peng, Qiyu; Moses, William W.

    2009-03-20

    Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe both our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.

  10. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease

    OpenAIRE

    Collins, Allan J.; Foley, Robert N.; Gilbertson, David T.; Chen, Shu-Cheng

    2015-01-01

    The United States Renal Data System (USRDS) began in 1989 through US Congressional authorization under National Institutes of Health competitive contracting. Its history includes five contract periods, two of 5 years, two of 7.5 years, and the fifth, awarded in February 2014, of 5 years. Over these 25 years, USRDS reporting transitioned from basic incidence and prevalence of end-stage renal disease (ESRD), modalities, and overall survival, as well as focused special studies on dialysis, in th...

  11. Distal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  12. Proximal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  13. Bilateral parvus-tardus Doppler waveform in renal arteries suggests aortic coarctation: case report

    Energy Technology Data Exchange (ETDEWEB)

    Conkbayir, I.; Yanik, B.; Keyik, B.; Edguer, T.; Hekimoglu, B. [Social Security Ankara Hospital, Dept. of Radiology, Diskapi, Ankara (Turkey)]. E-mail: iconkbayir@yahoo.com

    2004-02-01

    Doppler ultrasonography (US) is an effective, inexpensive and widely used modality in renal vascular imaging. Demonstration of a parvus-tardus waveform pattern in renal arteries or intrarenal segmental arteries with Doppler US indicates a significant proximal stenosis. In the presence of a parvus-tardus pattern in both renal arteries, bilateral renal artery stenosis or a stenosis more proximal to the renal arteries should be considered.{sup 1} We present such a case and describe the Doppler ultrasonographic findings that suggested coarctation of the aorta. (author)

  14. Renale Osteopathie

    Directory of Open Access Journals (Sweden)

    Horn S

    2001-01-01

    Full Text Available Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Therapiemöglichkeiten. Wir beeinflussen dadurch nicht nur die Morbidität und Lebensqualität, sondern auch die Mortalität unserer Patienten.

  15. Determination of Stress Histories in Structures by Natural Input Modal Analysis

    DEFF Research Database (Denmark)

    Hjelm, Henrik P.; Brincker, Rune; Graugaard-Jensen, Jesper;

    2005-01-01

    In this paper it is shown that stress histories can be estimated with high accuracy by integrating measured accelerations to obtain displacement and then performing a modal decomposition of the so estimated displacements. The relation between the modal coordinate and the stress in an arbitrary po....... It is shown that the so estimated stress histories can replace strain gauge measurements in many cases, and it allows for an accurate estimation of fatigue damage....

  16. Radiation Source Replacement Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, Jeffrey W.; Moran, Traci L.; Bond, Leonard J.

    2010-12-01

    This report summarizes a Radiation Source Replacement Workshop in Houston Texas on October 27-28, 2010, which provided a forum for industry and researchers to exchange information and to discuss the issues relating to replacement of AmBe, and potentially other isotope sources used in well logging.

  17. Renal disease in pregnancy.

    Science.gov (United States)

    Thorsen, Martha S; Poole, Judith H

    2002-03-01

    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  18. Conservative treatment modalities in retinoblastoma

    Directory of Open Access Journals (Sweden)

    Bhavna Chawla

    2013-01-01

    Full Text Available Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. The purpose of this article is to review the literature on various conservative treatment modalities available for the treatment of retinoblastoma and their effectiveness, when used alone or in combination. Pubmed, Medline, Embase, and the Cochrane library were searched through 2012 for published peer reviewed data on conservative treatment modalities for retinoblastoma. Various studies show that while enucleation remains the standard of care for advanced intraocular tumors, conservative modalities that can result in globe salvage and preservation of useful vision are being increasingly employed. Such modalities include systemic chemotherapy, focal consolidation with transpupillary thermotherapy, laser photocoagulation and cryotherapy, plaque brachytherapy, and delivery of local chemotherapy using subconjunctival, sub-tenon, or intra-arterial routes. When used alone or in combination, these treatment modalities can help in avoidance of external beam radiotherapy or enucleation, thus reducing the potential for long-term side effects, while salvaging useful vision. Radioactive plaque brachytherapy has an established role in selected patients with intraocular retinoblastoma. Local injections of chemotherapeutic agents via the sub-tenon or sub-conjunctival route have been used with varying degrees of success, usually as an adjunct to systemic chemotherapy. Intra-arterial ophthalmic artery delivery of melphalan has shown promising results. It is important to recognize that today, several treatment options are available that can obviate the need for enucleation, and cure the cancer with preservation of functional vision. A thorough knowledge and understanding of these conservative treatment modalities is essential for appropriate management.

  19. Clinical outcomes of end stage renal disease and adequacy of adult maintenance hemodialysis patients

    OpenAIRE

    Ismail Mahmud Ali, Amirthalingam R

    2014-01-01

    Background & Aim: End stage renal disease (ESRD) is an irreversible loss of kidney function caused by various risk factors and affected persons of lives mainly depending on the technology of renal replacement therapy (RRT) or renal transplantation (RT) to sustain the life. Aim of this study is to overview the clinical outcomes of ESRD and adequacy of maintenance hemodialysis among the patients. Materials & Methods: Currently, there are sixty two end stage renal disease patient’s clinical data...

  20. Linear contextual modal type theory

    DEFF Research Database (Denmark)

    Schack-Nielsen, Anders; Schürmann, Carsten

    Abstract. When one implements a logical framework based on linear type theory, for example the Celf system [?], one is immediately con- fronted with questions about their equational theory and how to deal with logic variables. In this paper, we propose linear contextual modal type theory that giv...... a mathematical account of the nature of logic variables. Our type theory is conservative over intuitionistic contextual modal type theory proposed by Nanevski, Pfenning, and Pientka. Our main contributions include a mechanically checked proof of soundness and a working implementation....

  1. Ultrasonographic imaging for structural characterization of renal affections and diagnosis of associated chronic renal failure in 10 dogs.

    Science.gov (United States)

    Kumar, Vijay; Kumar, Adarsh; Varshney, A C

    2011-01-01

    The present study comprises of 10 dogs of either sex with primary indication of azotaemia. All the dogs were subjected to detailed clinical, haematobiochemical, urinalysis, and microbiological examination along with radiographical and ultrasonographical examination. Based on the ultrasonographic structural abnormalities, the different renal affections associated with CRF in majority of dogs were diagnosed. The different affections included "end-stage" kidneys (n = 4), hydronephrosis (n = 1), renomegaly (n = 1), nephritis (n = 1), nephrolithiasis (n = 1), nephrocalcinosis (n = 1), and renal cyst (n = 1). The significant ultrasonographic features in these affections included small kidneys with loss of corticomedullary demarcation ("end-stage" kidneys); increased cortical echogenicity (nephritis); dilation of the renal pelvis, separation of the central renal sinus with anechoic space, atrophy of renal medulla, (hydronephrosis); enlarged kidneys with increased overall echogenicity of renal cortex (renomegaly and associated nephritis); hyperechoic-mineralized structure with shadowing (nephrolithiasis); diffuse, small, multiple hyperechoic structures in the renal parenchyma with distal acoustic shadowing (nephrocalcinosis); small spherical intercortical anechoic structures fluid (renal cysts). In the present study, ultrasound proved to be a quick, convenient, and sensitive modality in detecting alterations in renal size and parenchymal architecture. All the dogs so diagnosed with CRF were rendered conservative medical treatment to control clinical signs of uraemia; maintain adequate fluid, electrolyte, and acid/base balance; provide adequate nutrition; minimize progression of renal failure.

  2. Determination of cefoperazone and sulbactam by LC-MS/MS in plasma and ultrafiltrate of patients undergone continuous renal replacement therapy%液相色谱-串联质谱法测定连续肾脏替代治疗患者血浆及超滤液中头孢哌酮与舒巴坦浓度

    Institute of Scientific and Technical Information of China (English)

    王睿华; 程龙妹; 曲恒燕; 郝光涛; 刘泽源; 夏鹄

    2015-01-01

    Objective To establish a sensitiv e and specific LC-MS/MS method for the simultaneous determination of cefoperazone and sulbactam in plasma and ultrafiltrate of patients undergone continuous renal replacement therapy(CRRT). Methods Cefuroxime axetil was used as the internal standard,the plasma samples were separated on an WatersAtlantis dC18 column (150 mm× 4.6 mm, 5.0 μm). A tandem mass spectrometer equipped with ESI was used as the detector and operated in the mode of multiple reaction monitoring.Quantitive analysis of[M-H]-ions were m/z 644.1→528.1(cefoperazone), m/z 231.8→188.0(sulbactam) and m/z 509.3→206.9(the internal standard, IS), respectively. Results The linear range of cefoperazone and sulbactam in human plasma and ultrafiltrate were(10-500) and(6-300)μg/ml, respectively. Extraction recoveries were more than 90.0%, and intra- and inter-day relative standard deviation was less than 15%. The matrix effect of plasma and ultrafiltrate showed that the matrix effect of the two media had little influence on the measurement of cefoperazone, sulbactam and IS. Conclusion The method is simple, fast, and highly sensitive. The two drugs can be detected simultaneously in the same sample. It is appropriate to monitor drug concentration in plasma and ultrafiltrate of the patients undergone CRRT. Sieving coefficient could be calculated and provide an accurate basis for dose adjustment.%目的:建立液相色谱-串联质谱法(LC-MS/MS)测定连续肾脏替代治疗(continuous renal replacement therapy, CRRT)患者血浆及超滤液中头孢哌酮与舒巴坦浓度。方法以头孢呋辛酯为内标,采用WatersAtlantis dC18色谱柱(150 mm×4.6 mm,5.0μm)进行分离,通过串联质谱仪,以多反应监测方式进行测定。用于定量分析的离子对分别是m/z 644.1→528.1(头孢哌酮)、m/z 231.8→188.0(舒巴坦)和m/z 509.3→206.9〔头孢呋辛酯,内标(IS)〕。结果头孢哌酮在10~500

  3. Renal calculus

    CERN Document Server

    Pyrah, Leslie N

    1979-01-01

    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  4. Clinical analysis of the continuous renal replacement therapy in patients with the intractable heart failure based on 12case studies%12例难治性心衰患者应用连续性肾脏替代疗法治疗的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    李鹏

    2012-01-01

      目的:探讨连续性肾脏替代疗法(CRRT)在救治难治性心衰患者中的应用。方法:回顾分析了12例经常规药物治疗效果不佳后接受CRRT治疗的难治性心衰患者的临床资料。结果:患者经过CRRT治疗后,症状与心功能分级明显改善,脑钠肽(BNP)水平明显降低。结论:应用CRRT减低心脏负荷、减少心脏做功,使心脏耗氧量减少,心衰症状缓解,效果显著,为难治性心衰治疗提供了一个新思路。%  Objective: To research the effect of the continuous renal replacement therapy(CRRT) in patients with the intractable heart failure. Methods:The clinical data from 12patients of the intractable heart failure treated by CRRT were reviewed and analyzed. Results: After CRRT, the clinical symptoms and cardiac function of the majority of the patients were improved, and the level of the Brain Natriuretic Peptid were obviously lowered. Conclusion: The application of CRRT can reduce the preload of the heart and improve the left heart function. So It is a new method for treatment the intractable heart failure.

  5. Comparison of peritoneal dialysis versus continuous renal replacement therapy in the treatment of acute kidney injury in infants with congenital heart disease after surgery%腹膜透析和血液滤过治疗婴幼儿先天性心脏病术后并发急性肾功能损害疗效比较

    Institute of Scientific and Technical Information of China (English)

    郑萍; 柳梅; 袁媛

    2015-01-01

    目的 比较持续腹膜透析和持续血液滤过治疗在先天性心脏病手术后婴幼儿并发急性肾功能损害的治疗效果.方法 回顾性分析2012年1月到2013年12月间3岁以下,行先天性心脏病手术后并发急性肾功能损害婴幼儿95例的临床资料.其中,腹膜透析治疗患儿52例(腹膜透析 组),持续血液滤过治疗患儿43例(血液滤过治疗组).比较两组患儿手术后液体出超的时间(液体出量开始大于入量的时间)、乳酸恢复正常时间、术后呼吸机辅助时间、住ICU时间、术后住院时间和病死率.结果 两组患儿性别、年龄、体重、疾病、手术中阻断时间和体外循环时间差异没有统计学意义.腹膜透析组液体出超的时间为(22.3±4.2)h,血液滤过治疗组为(14.2±3.6)h,组间比较,差异有统计学意义(P<0.01).腹膜透析组术后乳酸恢复到正常时间为(10.3±5.2)h,血液滤过治疗组为(6.8±3.4)h,组间比较,差异有统计学意义(P<0.05).腹膜透析组术后呼吸机辅助时间为(22.1±5.3)h较血液滤过治疗组(15.6±4.2)h明显延长,差异有统计学意义(P<0.01).腹膜透析组实际使用肾脏替代治疗时间为(85.4±11.7)h,血液滤过治疗组为(68.9±12.4)h,组间比较,差异有统计学意义(P<0.05).腹膜透析组术后住ICU时间为(8.2±3.6)d,较血液滤过治疗组(5.8±2.1)d时间长,差异有统计学意义(P<0.05).腹膜透析组术后住院时间为(16.2±4.4)d,血液滤过组为(15.2±3.2)d,差异没有统计学意义.结论 先天性心脏病手术后婴幼儿出现急性肾功能损害,使用血液滤过治疗较腹膜透析治疗效果更好,更快,更确切.%Objective To compare the efficacies of continuous peritoneal dialysis versus continuous renal replacement therapy for acute kidney injury in infants with congenital heart disease (CHD) after surgery.Methods Retrospective analyses were performed for a total of 95 CHD infants aged under 3 years with acute renal

  6. Wavefront reconstruction by modal decomposition

    CSIR Research Space (South Africa)

    Schulze, C

    2012-08-01

    Full Text Available We propose a new method to determine the wavefront of a laser beam based on modal decomposition by computer-generated holograms. The hologram is encoded with a transmission function suitable for measuring the amplitudes and phases of the modes...

  7. Arithmetic Memory Is Modality Specific.

    Directory of Open Access Journals (Sweden)

    Timothy Myers

    Full Text Available In regards to numerical cognition and working memory, it is an open question as to whether numbers are stored into and retrieved from a central abstract representation or from separate notation-specific representations. This study seeks to help answer this by utilizing the numeral modality effect (NME in three experiments to explore how numbers are processed by the human brain. The participants were presented with numbers (1-9 as either Arabic digits or written number words (Arabic digits and dot matrices in Experiment 2 at the first (S1 and second (S2 stimuli. The participant's task was to add the first two stimuli together and verify whether the answer (S3, presented simultaneously with S2, was correct. We hypothesized that if reaction time (RT at S2/S3 depends on the modality of S1 then numbers are retrieved from modality specific memory stores. Indeed, RT depended on the modality of S1 whenever S2 was an Arabic digit which argues against the concept of numbers being stored and retrieved from a central, abstract representation.

  8. Non-contrast magnetic resonance angiography in renal transplantation and renal donation

    DEFF Research Database (Denmark)

    Blankholm, Anne Dorte

    2015-01-01

    examination of living kidney donors. We compared CTA to an extensive MRI protocol without the use of contrast agents, including NCMRA, and to observations from living donor nephrectomy, which served as the reference standard. We concluded that an optimised MRI protocol without contrast agents could...... be substituted for CTA for preoperative vessel assessment in living kidney donors.......Renal transplantation is the treatment of choice in cases of severe renal disease. The majority of candidates for kidney transplantation have arteriosclerosis to some extent; thus, preoperative imaging of the vessels is needed. Different imaging modalities are available and are used...

  9. Renal actinomycosis with concomitant renal vein thrombosis.

    Science.gov (United States)

    Chang, Dong-Suk; Jang, Won Ik; Jung, Ji Yoon; Chung, Sarah; Choi, Dae Eun; Na, Ki-Ryang; Lee, Kang Wook; Shin, Yong-Tai

    2012-02-01

    Renal actinomycosis is a rare infection caused by fungi of the genus Actinomyces. A 74-year-old male was admitted to our hospital because of gross hematuria with urinary symptoms and intermittent chills. Computed tomography of the abdomen showed thrombosis in the left renal vein and diffuse, heterogeneous enlargement of the left kidney. After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis.

  10. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Robert Marcovich

    2003-06-01

    Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

  11. TRANSPLANTE RENAL

    Directory of Open Access Journals (Sweden)

    Soraia Geraldo Rozza Lopes

    2014-01-01

    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  12. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930564 Dwell times affect the local host de-fence mechanism of peritoneal dialysis patients.WANG Tao(汪涛),et al.Renal Instit,SunYatsen Med Univ,Guangzhou,510080.Chin JNephrol 1993;9(2):75—77.The effect of different intraperitoneal awelltimes on the local host defence in 6 peritonealdialysis patients was studied.A significant de-crease in the number of peritoneal cells,IgG con-centration and the phagoeytosis and bactericidalactivity of macrophages was determined when thedwell time decreased from 12 to 4 hs or form 4 to0.5hs,but the peroxidase activity in macrophagesincreased significantly.All variables,except theperoxidase activity in macrophages,showed nosignificant difference between patients of high or

  13. Traumatismo renal

    OpenAIRE

    Rocha, Sofia Rosa Moura Gomes da

    2009-01-01

    Introdução: A realização deste trabalho visa a elaboração de uma revisão sistematizada subordinada à temática da traumatologia renal. Objectivos: Os principais objectivos deste trabalho são: apurar a etiologia, definir a classificação, analisar o diagnóstico e expôr o tratamento e as complicações. Desenvolvimento: Os traumatismos são a principal causa de morte antes dos 40 anos. O rim é o órgão do aparelho génito-urinário mais frequentemente atingido. Os traumatismos renais são mais fre...

  14. Replacing a Missing Tooth

    Science.gov (United States)

    ... vessels in the tooth pulps are rather large. Drilling down these teeth for crowns may expose the ... porcelain replacement tooth is held in place by metal extensions cemented to the backs of the adjacent ...

  15. Hormone Replacement Therapy

    Science.gov (United States)

    ... before and during menopause, the levels of female hormones can go up and down. This can cause ... hot flashes and vaginal dryness. Some women take hormone replacement therapy (HRT), also called menopausal hormone therapy, ...

  16. Knee joint replacement

    Science.gov (United States)

    ... of your kneecap. Your kneecap is called the patella. The replacement part is usually made from a ... long. Then your surgeon will: Move your kneecap (patella) out of the way, then cut the ends ...

  17. Knee joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the ... to slide 4 out of 4 Overview The knee is a complex joint. It contains the distal ...

  18. Product Platform Replacements

    DEFF Research Database (Denmark)

    Sköld, Martin; Karlsson, Christer

    2012-01-01

    Purpose – It is argued in this article that too little is known about product platforms and how to deal with them from a manager's point of view. Specifically, little information exists regarding when old established platforms are replaced by new generations in R&D and production environments...... originality and value is achieved by focusing on product platform replacements believed to represent a growing management challenge....

  19. Scintigraphic features of duplex kidneys on DMSA renal cortical scans.

    Science.gov (United States)

    Kwatra, Neha; Shalaby-Rana, Eglal; Majd, Massoud

    2013-09-01

    The spectrum of manifestations of duplex kidneys on (99m)Tc-dimercaptosuccinic acid (DMSA) renal cortical scans and correlating findings on other imaging modalities are presented. Relevant embryology of the duplex systems and technical aspects of DMSA scintigraphy are reviewed.

  20. Glomerulonephritis and managing the risks of chronic renal disease.

    Science.gov (United States)

    Singh, Gurmeet R

    2009-12-01

    The rising global burden of chronic renal disease, the high cost of providing renal replacement therapies, and renal disease also being a risk factor for cardiovascular disease is increasing focus on renal disease prevention. This article focuses on the aspects of renal disease (specifically poststreptococcal glomerulonephritis [PSGN] and chronic kidney disease [CKD]) in Indigenous populations in Australia, New Zealand, Canada, and the United States that diverge from those typically seen in the general population of those countries. The spectrum of renal and many other diseases seen in Indigenous people in developed countries is similar to that seen in developing countries. Diseases like PSGN that have largely disappeared in developed countries still occur frequently in Indigenous people. CKD during the childhood years is due to congenital anomalies of the kidney and urinary tract in up to 70% of cases and occurs later in polycystic kidney disease and childhood-onset diabetes. Several risk factors for CKD in adulthood are already present in childhood.