scholarly journals Initiation and Cessation Timing of Renal Replacement Therapy in Patients with Type 1 Cardiorenal Syndrome: An Observational Study

2017 ◽  
Vol 7 (2) ◽  
pp. 118-127
Author(s):  
Buyun Wu ◽  
Wenyan Yan ◽  
Xing Li ◽  
Xiangqing Kong ◽  
Xiangbao Yu ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Urine Output ◽  
Rescue Therapy ◽  
Cardiorenal Syndrome ◽  
Optimal Timing ◽  
The Mean ◽  
Death Group

Background/Aims: Renal replacement therapy (RRT) is a rescue therapy for patients with type 1 cardiorenal syndrome (CRS) with poor prognoses. However, the optimal timing for initiation and cessation of RRT remains controversial. The purpose of this study was to determine the optimal timing of initiation and cessation of RRT for patients with type 1 CRS. Methods: In this retrospective analysis, patients with refractory type 1 CRS receiving RRT were divided into 3 groups according to weaning from RRT and death within 90 days. Baseline characteristics, underlying heart disease, comorbidities, drug use before RRT, indicators of RRT initiation, and prognosis were compared between the 3 groups. Results: Fifty-two patients were enrolled, which included 27 males and 25 females with a mean age of 70.7 ± 16.1 years and a 90-day mortality rate of 65.4%. The mean urine output before RRT initiation was 800 mL/ 24 h in the RRT-independent group, 650 mL/24 h in the RRT-dependent group, and 345 mL/ 24 h in the death group (p = 0.021). Additionally, there were obvious differences in fluid balance between the 3 groups (167, 250, and 1,270 mL, respectively, p = 0.016). Patients could be successfully weaned from RRT when urine output was >880 mL and fluid balance volume was <150 mL. Conclusion: The mean fluid balance of survivors was remarkably less than that of the death group at RRT initiation. RRT termination can be considered when urine output is >880 mL/24 h and volume balance is <150 mL/24 h.

scholarly journals POS0119 RENAL INVOLVEMENT AND NEED OF RENAL REPLACEMENT THERAPY IN ANCA ASSOCIATED VASCULITIS IN A SPANISH SINGLE-CENTER STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 270.2-271
Author(s):  
J. Álvarez Troncoso ◽  
J. C. Santacruz Mancheno ◽  
A. Díez Vidal ◽  
S. Afonso Ramos ◽  
A. Noblejas Mozo ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Granulomatosis With Polyangiitis ◽  
Renal Involvement ◽  
Age At Diagnosis ◽  
Systemic Involvement ◽  
Risk Of Death ◽  
Anca Associated Vasculitis ◽  
The Mean

Background:Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EPGA). Renal involvement is frequent in AAV and is an important factor for morbidity and mortality.Objectives:The main objective of this study was to analyze the demographic, clinical, histological and therapeutic characteristics of renal involvement in patients with AAV and the risk of renal replacement therapy (RRT) or death.Methods:Retrospective observational study of 56 patients with AAV fulfilling classificatory criteria and renal involvement diagnosed between 1995 and 2020 from a Spanish tertiary centre. We studied the histological involvement (according to the 2010 classification in focal, crescentic, mixed or sclerotic), immunofluorescence (IF) and the treatment received with the risk of RRT or death.Results:We included 56 patients diagnosed with AAV and renal involvement. The mean age was 61.08±4.05 years; 58.9% were women. The mean follow-up time of these patients was 16.14± 8.80 years. Only 57.1% of patients presented systemic involvement.Most frequent non-renal AAV manifestations were lung involvement (39.3%), central nervous system (30.4%), otorhinolaryngology (ORL) (14.3%), skin (8.9%) and cardiac involvement (8.9%). Main immunological findings were ANCA-MPO+ (69.6%), ANCA-PR3+ (23.2%), ANCA-negative (5.4%). Low C3 was found in 19.6% patients. Histologic classification (HC) and need of RRT is described in table 1. Main HC in renal AAV was crescentic, mixed, focal and sclerotic respectively. Eight patients had not biopsy performed. IF was positive for C3 deposits in 20 patients (35.7%). Half of the patients presented <50% normal glomeruli.The treatment of renal involvement in AAV in our cohort was as follows: 83.9% (47) corticosteroids (CS) and cyclophosphamide (of which 40 received intravenous and 7 oral cyclophosphamide; and 12 patients associated plasma exchange (PE) with this treatment), 5.36% CS alone, 2 patients received CS and mycophenolate; 1 CS and rituximab, 1 CS and PE, and 2 patients received no treatment. A total of 13 patients received PE and 18 RRT. The mean time to RRT was 65.44±32.72 months. Relapses were not uncommon, 33.93% of the patients presented ≥1 relapse and 10.71% presented ≥2.Infections were very frequent since they were present in 91.07% of the patients. Other frequent non-immunological complications observed in the follow-up of these patients were thrombosis in 31.14%, cardiovascular events in 28.57% and cancer in 19.64%.Patients with ANCA-PR3+ were younger at diagnosis (p<0.001), were more likely to present cardiac (p=0.045) and ORL involvement (p<0.001). However, neither ANCA-PR3+ nor ANCA-MPO+ were specifically associated with the need of RRT or higher risk of death in our cohort. Use of CS alone for the treatment of renal AAV was associated with higher mortality (p=0.006) but CS and cyclophosphamide with lower mortality (p=0.044). ANCA-negative patients were more likely to receive no treatment. Having <50% normal glomeruli and C3 deposits on IF were associated with an increased need for RRT. Presenting focal disease on HC was protective for the need of RRT. Older age at diagnosis, systemic involvement of AAV and need of RRT was associated with higher mortality.Conclusion:AAVs are complex vasculitides with frequent renal involvement. Increased C3 deposition, non-focal histological forms, and <50% normal glomeruli were related to the need for RRT. In turn, the need for RRT, a later age at diagnosis, and systemic involvement were associated with higher mortality. Holistic and multidisciplinary early management of AAVs in experience centers can help improve renal prognosis and decrease mortality.References:[1]Binda et al. ANCA-associated vasculitis with renal involvement. J Nephrol. 2018 Apr;31(2):197-208.[2]Kronbichler et al. Clinical associations of renal involvement in ANCA-associated vasculitis. Autoimmun Rev. 2020 Apr;19(4):102495.Disclosure of Interests:None declared

Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the allegheny county registry

2003 ◽  
Vol 42 (1) ◽  
pp. 117-124 ◽  
Author(s):  
Rimei Nishimura ◽  
Janice S Dorman ◽  
Zsolt Bosnyak ◽  
Naoko Tajima ◽  
Dorothy J Becker ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Allegheny County

scholarly journals Survival during Renal Replacement Therapy among African Americans Infected with HIV Type 1 in Urban Baltimore, Maryland

2007 ◽  
Vol 45 (12) ◽  
pp. 1625-1632 ◽  
Author(s):  
M. G. Atta ◽  
D. M. Fine ◽  
G. D. Kirk ◽  
S. H. Mehta ◽  
R. D. Moore ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
African Americans ◽  
Replacement Therapy ◽  
Hiv Type 1

Acute Kidney Injury and Renal Replacement Therapy

2020 ◽  
Author(s):  
Karen L. Krechmery ◽  
Diego Casali
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
End Stage Renal Disease ◽  
Kidney Injury ◽  
Treatment Modalities ◽  
Optimal Timing ◽  
Timing Of Initiation ◽  
Stage Renal Disease ◽  
End Stage

Acute kidney injury (AKI) is a common syndrome encountered in critical illness and is associated with significant morbidity and increased mortality. Despite attempts to prevent the development of AKI, its incidence continues to rise, probably due to increased recognition in the setting of clearer definitions of the stages of AKI. Despite advances in the field of Nephrology, the treatment of AKI and its complications remains difficult in clinical practice. Critical care clinicians must have an understanding of the current definitions, pathophysiology, and treatment modalities. Renal replacement therapy (RRT) is a mainstay of treatment, but a lack of consensus regarding the optimal timing for initiation remains. There is a need for further research regarding both the timing of initiation of RRT and biomarkers that might allow earlier detection, differentiation of etiologies and monitoring of interventions. This review contains 3 figures, 4 tables, and 31 references Key Words: acute kidney injury (AKI), KDIGO, renal replacement therapy (RRT), risk, injury, failure, loss of kidney function, end stage renal disease (RIFLE), nephrology  

scholarly journals 1340. The Effect of Continuous Renal Replacement Therapy on Body Temperature in Patients with and without Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S485-S485
Author(s):  
Douglas W Challener ◽  
Kianoush Kashani ◽  
John C O’Horo
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Generation Cephalosporin ◽  
Temperature Data ◽  
Fourth Generation ◽  
Antibiotic Administration ◽  
Mean Temperature ◽  
The Mean

Abstract Background Sepsis frequently leads to acute kidney injury. In severe cases, patients may require continuous renal replacement therapy (CRRT) which involves placement of a dialysis catheter and an extracorporeal blood filtration circuit. CRRT is commonly considered to “mask” fever, though this phenomenon has not been investigated. Methods We queried an institutional database of all patients on CRRT from 2007 to 2015 for inpatient temperature data and antibiotic administration records. Receipts of piperacillin–tazobactam, a carbapenem, or a third or fourth-generation cephalosporin, indicating a serious infection, were considered intervention arm. We analyzed temperatures recorded in the intensive care unit before, during, and after CRRT. Patients were divided into groups that did not receive antibiotics as well as those who did. Temperature data were Winsorized to correct for outliers. We also performed descriptive statistics for each group. Results There were 237,988 temperature readings for 1,568 ICU patients on CRRT. 1,153 patients received broad-spectrum antibiotics in ICU. In patients who received antibiotics in ICU and were presumed to have an infection, the mean temperature was 37.2°C prior to initiation of CRRT, 36.8°C while on CRRT, and 37.2°C following discontinuation of CRRT. In the 415 patients who did not receive IV antibiotics, the mean temperature was 36.9°C prior to initiation of CRRT, 36.6°C while on CRRT, and 37.0°C following discontinuation of CRRT. During each of the periods before, during, and after CRRT, patients who received antibiotics had significantly higher temperatures than those who did not (P < 0.001). Patients receiving antibiotics were generally younger (mean 60 years vs. 64 years, P < 0.001), had longer ICU stays (mean 29 days vs. 12 days, P < 0.001) and spent more time being ventilated (mean 23 days vs. 7 days, P < 0.001). The mean SOFA score on day one was similar (mean 11.1 in the antibiotic group and 10.5 in the other group). Conclusion This investigation suggests that patients have slightly lower temperatures while on CRRT, by on average less than half a degree. A similar effect is seen in both patients with infections as well as those without. Further work will be needed to determine what constitutes a true febrile response in this population. Disclosures All authors: No reported disclosures.

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

Pharmacokinetics of Benzylpenicillin (Penicillin G) during Prolonged Intermittent Renal Replacement Therapy

Chemotherapy ◽  
2019 ◽  
Vol 64 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Vesa Cheng ◽  
Matthew Rawlins ◽  
Tim Chang ◽  
Emma Fox ◽  
John Dyer ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Penicillin G ◽  
Blood Samples ◽  
Staphylococcus Aureus Bacteremia ◽  
The Mean ◽  
Intermittent Renal Replacement Therapy

Prolonged intermittent renal replacement therapy (PIRRT) is an increasingly adopted method of renal replacement in critically ill patients. Like continuous renal replacement therapy, PIRRT can alter the pharmacokinetics (PK) of many drugs. In this setting, dosing data for antibiotics like benzylpenicillin are lacking. In order to enable clinicians to prescribe benzylpenicillin safely and effectively, knowledge of the effects of PIRRT on the plasma PK of benzylpenicillin is required. Herein, we describe the PK of benzylpenicillin in 2 critically ill patients on PIRRT for the treatment of penicillin-susceptible Staphylococcus aureus bacteremia complicated by infective endocarditis. Blood samples were taken for each patient taken over dosing periods during PIRRT and off PIRRT. Two-compartment PK models described significant differences in the mean clearance of benzylpenicillin with and without PIRRT (6.61 vs. 3.04 L/h respectively). We would suggest a benzylpenicillin dose of 1,800 mg (3 million units) every 6-h during PIRRT therapy as sufficient to attain PK/pharmacodynamic target.

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