Archive for the ‘Acute Kidney Injury’ Category

February 9, 2017

AKI and Long-Term Risk for Cardiovascular Events and Mortality

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This systematic review and meta-analysis of 25 studies involving 254 408 patients assessed whether AKI associates with long-term cardiovascular disease. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, General Nephrology
February 9, 2017

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

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This systematic review included 150 trials with 31,631 participants and 4,182 contrast-induced AKI events assessing 12 different interventions. The conclusion was that high-dose statin plus NAC or high-dose statin alone were ranked the one/two for preventing contrast-induced AKI with no significant changes noted in metaregressions or subgroup and sensitivity analyses.  

No Comments Posted in Acute Kidney Injury, Contrast Nephropathy
November 11, 2016

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

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The authors of this study developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery.  They 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, […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Hemodialysis
August 14, 2016

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

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   This multicenter randomized trial assigned 620 ICU patients with severe stages 1-3 AKI with either an early dialysis start (at randomization) or late dialysis start (a classic indication to initiate).  The primary outcome was survival at day 60.  There was no survival difference between the groups at day 60; 150 deaths occurred among 311 […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
May 29, 2016

Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury The ELAIN Randomized Clinical Trial

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This single-center randomized clinical trial of 231 critically ill patients with AKI KDIGO stage 2 looked at early (within 8 hours of diagnosis of KDIGO stage 2; n = 112) or delayed (within 12 hours of stage 3 AKI or no initiation; n = 119) initiation of RRT.  The results show that early initiation of RRT significantly reduced 90-day mortality (39.3% vs 54.7%).  More patients in the early group recovered renal function by day 90 (53.6% vs 38.7%) in the delayed group.  Furthermore, duration of […]

No Comments Posted in Acute Kidney Injury, Clinical Trial Results, Hemodialysis
March 23, 2016

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge.

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This retrospective cohort study examined 4738 patients with KDIGO stage 3 AKI admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days.   There was no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT.  

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
March 23, 2016

Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis

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This study randomized patients with LN (class III, IV, or V) to receive induction with low-dose CYC or oral MMF with the exclusion of patients with crescentic LN, a serum creatinine over 265 μmol/l, and neurological or pulmonary lupus were excluded. Maintenance therapy with azathioprine and low-dose corticosteroid was started at end of induction therapy. The complete remission rate was 50% in CYC and […]

No Comments Posted in Acute Kidney Injury, General Nephrology, Glomerulonephritis
November 30, 2015

Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury

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This 12-center open-label pilot trial of critically ill adults with volume replete severe AKI randomized atients were randomized to accelerated (12 h or less from eligibility) or standard RRT initiation. The enrollment median serum creatinine was 268 micromoles/l and urine output was 356 ml per 24 h. Clinical outcomes at 90 days included mortality which was 38% in the accelerated and 37% in the standard arm. The feasibility […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
September 21, 2015

Randomized Trial of Bicarbonate or Saline Study for the Prevention of Contrast-Induced Nephropathy in Patients with CKD

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Sodium bicarbonate vs sodium chloride has always plagued those of us trying to prevent acute contrast nephropathy.  This prospective, double-blind, multicenter randomized clinical trial of 391 with eGFR < 45 ml/min were randomized to either infusion.  There was no difference in the primary composite outcome of mortality, dialysis, or a sustained 20% reduction in eGFR at 6 months […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Contrast Nephropathy
July 13, 2015

Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery A Randomized Clinical Trial

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This very interesting multicentre Cleveland Clinic study looked at remote ischemic preconditioning (3 cycles of 5-minute ischemia and 5-minute reperfusion in one upper arm after induction of anesthesia) or sham remote ischemic preconditioning (control), both via blood pressure cuff inflation in high-risk patients undergoing cardiac surgery.  These results show that ischemic preconditioning significantly reduced both the rate of acute […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
March 18, 2015

Emerging treatments for amyloidosis

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This review briefs us on the novel approaches for the treatment of amyloidosis.  These targeted therapies may be better options for a disease that frequently has a very poor prognosis.

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, General Nephrology, Review
March 18, 2015

Renal dysfunction in cirrhosis is not just a vasomotor nephropathy

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This mini-review discusses the factors implicated in the development of hepatorenal syndrome in patients with progressive cirrhosis.

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Review
January 24, 2015

Risk of adverse events among older adults following co-prescription of clarithromycin and statins notmetabolized by cytochrome P450 3A4.

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 Among older adults taking a statin not metabolized by CYP3A4 (rosuvastatin/pravastatin/fluvastatin), co-prescription of clarithromycin versus azithromycin was associated with a modest but statistically significant increase in the 30-day absolute risk of adverse outcomes, including AKI and admission with hyperkalemia.

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