Critically Ill Patients Requiring Acute Renal Replacement Therapy Are at an Increased Risk of Long-Term Renal Dysfunction, but Rarely Receive Specialist Nephrology Follow-Up

Nephron ◽  
2015 ◽  
Vol 129 (3) ◽  
pp. 164-170 ◽  
Author(s):  
Christopher J. Kirwan ◽  
Mark J. Blunden ◽  
Hamish Dobbie ◽  
Ajith James ◽  
Ambika Nedungadi ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Increased Risk

scholarly journals Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study

Critical Care ◽  
2012 ◽  
Vol 16 (5) ◽  
pp. R197 ◽  
Author(s):  
Suvi T Vaara ◽  
Anna-Maija Korhonen ◽  
Kirsi-Maija Kaukonen ◽  
Sara Nisula ◽  
Outi Inkinen ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fluid Overload ◽  
Increased Risk

scholarly journals Micafungin Plasma Levels Are Not Affected by Continuous Renal Replacement Therapy: Experience in Critically Ill Patients

2017 ◽  
Vol 61 (8) ◽  
Author(s):  
M. G. Vossen ◽  
D. Knafl ◽  
M. Haidinger ◽  
R. Lemmerer ◽  
M. Unger ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
High Dose ◽  
Continuous Hemodiafiltration ◽  
Time Points ◽  
Continuous Venovenous Hemodiafiltration ◽  
Increased Risk

ABSTRACT Critically ill patients often experience acute kidney injury and the need for renal replacement therapy in the course of their treatment in an intensive care unit (ICU). These patients are at an increased risk for candidiasis. Although there have been several reports of micafungin disposition during renal replacement therapy, to this date there are no data describing the elimination of micafungin during high-dose continuous venovenous hemodiafiltration with modified AN69 membranes. The aim of this prospective open-label pharmacokinetic study was to assess whether micafungin plasma levels are affected by continuous hemodiafiltration in critical ill patients using the commonly employed AN69 membrane. A total of 10 critically ill patients with micafungin treatment due to suspected or proven candidemia were included in this trial. Prefilter/postfilter micafungin clearance was measured to be 46.0 ml/min (±21.7 ml/min; n = 75 individual time points), while hemofilter clearance calculated by the sieving coefficient was 0.0038 ml/min (±0.002 ml/min; n = 75 individual time points). Total body clearance was measured to be 14.0 ml/min (±7.0 ml/min; n = 12). The population area under the curve from 0 to 24 h (AUC0–24) was calculated as 158.5 mg · h/liter (±79.5 mg · h/liter; n = 13). In spite of high protein binding, no dose modification is necessary in patients receiving continuous venovenous hemodiafiltration with AN69 membranes. A dose elevation may, however, be justified in certain cases. (This study has been registered at ClinicalTrials.gov under identifier NCT02651038.)

scholarly journals The Effect of Long-Term Duration Renal Replacement Therapy on Outcomes of Critically Ill Patients with Acute Kidney Injury: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Mengmeng Yang ◽  
Yun Li ◽  
Peiyao Li ◽  
Yong Fan ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Long Duration ◽  
Significant Difference ◽  
The Difference

Background. Renal replacement therapy (RRT), as a cornerstone of supportive treatment, has long been performed in critically ill patients with acute kidney injury (AKI). However, the majority of studies may have neglected the effect of the duration of RRT  on the outcome of AKI patients. This paper is aiming to explore the effect of the long duration of RRT  on the outcome of critically ill patients with AKI. Methods. This retrospective study was conducted by using the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. The primary outcome measure of this study was the mortality at 28 days, 60 days, and 90 days in the long-duration RRT group and the non-long-duration RRT group. The secondary outcomes assessed the difference in clinical outcome in these two groups. Lastly, the effect of the duration of RRT on mortality in AKI patients was determined as the third outcome. Results. We selected 1,020 patients in total who received RRT according to the MIMIC-II database. According to the inclusion and exclusion criteria, we finally selected 506 patients with AKI: 286 AKI patients in the non-long-duration RRT group and 220 in the long-duration RRT group. After 28 days, there was a significant difference in all-cause mortality between the long-duration RRT group and the non-long-duration RRT group ( P = 0.001 ). However, the difference disappeared after 60 days and 90 days ( P = 0.803 and P = 0.925 , respectively). The length of ICU stay, length of hospital stay, and duration of mechanical ventilation were significantly longer in the long-duration RRT group than those in the non-long-duration RRT group. Considering 28-day mortality, the longer duration of RRT was shown to be a protective factor (HR = 0.995, 95% CI 0.993–0.997, P < 0.0001 ), while 60-day and 90-day mortality were not correlated with improved protection. Conclusions. The long duration of RRT can improve the short-term prognosis of AKI patients, but it does not affect the long-term prognosis of these patients. Prognosis is determined by the severity of the illness itself. This suggests that RRT can protect AKI patients through the most critical time; however, the final outcome cannot be altered.

scholarly journals Characterisation of Acute Kidney Injury in Critically Ill Patients with Severe Coronavirus Disease-2019 (COVID-19)

2020 ◽  
Author(s):  
Sébastien Rubin ◽  
Arthur Orieux ◽  
Renaud Prevel ◽  
Antoine Garric ◽  
Marie-Lise Bats ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
University Hospital ◽  
Urinary Analysis ◽  
Stage 1

AbstractBackgroundCOVID-19-associated acute kidney injury frequency, severity and characterisation in critically ill patients has not been reported.MethodsSingle-center cohort performed from March 3, 2020, to April 14, 2020 in 4 intensive care units in Bordeaux University Hospital, France. All patients with COVID19 and pulmonary severity criteria were included. AKI was defined using KDIGO criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterisation (transient vs. persistent acute kidney injury; proteinuria, hematuria and glycosuria), and short-term outcomes was evaluated.Results71 patients were included, with basal serum creatinine of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median follow-up was 17 [12–23] days. AKI developed in a total of 57/71 (80%) patients with 35% Stage 1, 35% Stage 2, and 30% Stage 3 acute kidney injury; 10/57 (18%) required renal replacement therapy. Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median urine protein/creatinine of 82 [54–140] (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20 indicating predominant tubulo-interstitial injury. Only 2 (4%) patients had glycosuria. At Day 7 onset of after AKI, six (11%) patients remained dependent on renal replacement therapy, nine (16%) had SCr > 200 µmol/L, and four (7%) died. Day 7 and day 14 renal recovery occurred in 28% and 52 % respectively.ConclusionCOVID-19-associated AKI is frequent, persistent severe and characterised by an almost exclusive tubulo-interstitial injury without glycosuria.

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