scholarly journals P0628CREATININE-CYSTATIN C RATIO IS ASSOCIATED WITH MORTALITY IN ICU PATIENTS UNDERGOING CONTINUOUS RENAL REPLACEMENT THERAPY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chan-Young Jung ◽  
Wonji Jo ◽  
Jaeyoung Kim ◽  
Jung Tak Park
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Muscle Mass ◽  
Cystatin C ◽  
Kidney Injury ◽  
Icu Patients ◽  
Prediction Of Mortality

Abstract Background and Aims Development of acute kidney injury (AKI) in intensive care patients considerably increases the risk of mortality. Although several factors that are related to outcome have been recognized in this patient group, stratifying mortality risk still remains a challenge. While serum creatinine levels are confounded by muscle wasting in critical illness, cystatin C is expected to be less modulated by muscle mass. Speculating that the ratio between serum creatinine and cystatin C may reflect muscle mass in critically ill AKI patients, we evaluated the association between creatinine-cystatin C ratio and mortality in patients requiring continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). Method Retrospective analyses were conducted on 443 ICU patients who underwent CRRT between August 2009 and October 2016 at Severance Hospital of Yonsei University Health System, Seoul, South Korea. The patients were divided into four groups based on creatinine-cystatin C ratio at the time of CRRT commencement. The primary outcome was 90-day mortality after CRRT initiation. Results The mean age was 64 ± 15 years, and 57.3% of patients were male. The most common cause of AKI was sepsis. The median and range of the creatinine-cystatin C ratio was 0.83 (0.13-6.20). The 90-day mortality rate for each creatinine-cystatin C ratio quartiles 1, 2, 3, and 4 were 76.6%, 73.9%, 61.3%, and 51.8%, respectively. Multiple Cox proportional hazard models revealed that the creatinine-cystatin C ratio was an independent predictor of 90-day mortality even after adjusting for confounding factors (Hazard ratio, 0.97; 95% confidence interval, 0.95-0.99, P<0.01). The prediction of mortality was significantly improved when creatinine-cystatin C ratio was considered compared to APACHE-II or SOFA scores alone. Conclusion Creatinine-cystatin C ratio is associated with mortality in ICU patients undergoing CRRT, and may be a practical marker in predicting survival among ICU patients with AKI.

scholarly journals Acute kidney injury incidence and acute renal replacement modality in intensive care unit patients in Indonesia: A result from Southeast Asia-Acute Kidney Injury Study

2020 ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Southeast Asia ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Three Stages

Abstract Background : Currently, there is limited data of large databases of acute kidney injury (AKI) epidemiology from Southeast Asia, especially in Indonesia, the biggest countries in. Therefore, we aimed to provide demographic data of intensive care unit (ICU) patients with AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : We collected demographic and clinical data from 952 ICU patients. Patients were classified into AKI and non-AKI. AKI was classified according to the Kidney Disease Improving Global Outcome (KDIGO) criteria in three stages. We then assess the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI patients. RRT modalities were listed down by the number of procedures conducted. Results : Overall incidence of AKI was 43%, distributed among three stages: 18.5 % stage 1, 33% stage 2, 48.5 % stage 3. Patients developing AKI need mechanical ventilation more often in comparison with non-AKI. Patients with AKI have an average APACHE score of 16.5, while non-AKI patients have an average score of 9.9. Among AKI patients, 24.6% requires RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions: This study showed that AKI is a common problem in Indonesian ICU with containing a high mortality rate. We strongly believe that identification the risk factor of AKI will provide the opportunity to develop the predictability score for AKI prevention and finally improve AKI outcome.

scholarly journals Continuous renal replacement therapy: understanding the foundations applied to pediatric patients

2019 ◽  
pp. S39-S45
Author(s):  
Evelyn Obando ◽  
Eliana López ◽  
David Montoya ◽  
Jaime Fernández Sarmiento
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Rational Approach ◽  
Daily Dialysis ◽  
Continuous Renal Replacement Therapies

Continuous renal replacement therapy (CRRT) is a well-established supportive treatment for acute kidney injury in pediatric intensive care units. Knowing its basic aspects allows a rational approach to therapy, making this therapeutic option a more adaptable treatment for individual patient. Different strategies may be used in the same child, depending on the clinical situation and the changes that may present throughout the clinical course. This article explains the physical principles, modalities of continuous renal replacement therapies, and membrane and filter characteristics in order to better understand the transmembrane transport of fluids and solutes in continuous renal replacement therapy.Abbreviations: CRRT= Continuous renal replacement therapy; SCUF = Slow continuous ultrafiltration therapies; FF = Filtration fraction; CVVH = Continuous venovenous hemofiltration; AKI = Acute kidney injury; CVVHD = Continuous venovenous hemodialysis; CVVHDF = Continuous venovenous hemodiafiltration; SLEDD = Sustained low-efficiency daily dialysis, EDDf = Extended daily dialysis with filtration, PDIRRT = Prolonged daily intermittent renal replacement therapyCitation: Obando E, López E, Montoya D, Fernández-Sarmiento J. Continuous renal replacement therapy: understanding the foundations applied to pediatric patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S39-S45

Continuous renal replacement therapy for critically ill patients in the intensive care units of two tertiary hospitals. v1

2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Scores

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.

scholarly journals A Comparison between Endostatin and Conventional Biomarkers on 30-Day Mortality and Renal Replacement Therapy in Unselected Intensive Care Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1603
Author(s):  
Toralph Ruge ◽  
Anders Larsson ◽  
Miklós Lipcsey ◽  
Jonas Tydén ◽  
Joakim Johansson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Icu Patients ◽  
Intensive Care Patients ◽  
General Populations ◽  
Kidney Impairment ◽  
Predicted Risk

Endostatin may predict mortality and kidney impairment in general populations as well as in critically ill patients. We decided to explore the possible role of endostatin as a predictor of 30-day mortality, acute kidney injury (AKI), and renal replacement therapy (RRT) in a cohort of unselected intensive care unit (ICU) patients. Endostatin and creatinine in plasma were analyzed and SAPS3 was determined in 278 patients on ICU arrival at admission to a Swedish medium-sized hospital. SAPS3 had the highest predictive value, 0.85 (95% C.I.: 0.8–0.90), for 30-day mortality. Endostatin, in combination with age, predicted 30-day mortality by 0.76 (95% C.I.: 0.70–0.82). Endostatin, together with age and creatinine, predicted AKI with 0.87 (95% C.I.: 0.83–0.91). Endostatin predicted AKI with [0.68 (0.62–0.74)]. Endostatin predicted RRT, either alone [0.82 (95% C.I.: 0.72–0.91)] or together with age [0.81 (95% C.I.: 0.71–0.91)]. The predicted risk for 30-day mortality, AKI, or RRT during the ICU stay, predicted by plasma endostatin, was not influenced by age. Compared to the complex severity score SAPS3, circulating endostatin, combined with age, offers an easily managed option to predict 30-day mortality. Additionally, circulating endostatin combined with creatinine was closely associated with AKI development.

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