scholarly journals Outcomes after Acute Peritoneal Dialysis for Critical Cardiorenal Syndrome Type 1

2021 ◽  
pp. 1-9
Author(s):  
Watanyu Parapiboon ◽  
Tanit Kingjun ◽  
Laddaporn Wongluechai ◽  
Waraporn Leawnoraset
Keyword(s):  
Peritoneal Dialysis ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Fluid Balance ◽  
Multivariable Analysis ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Resource Limited ◽  
Limited Setting

<b><i>Introduction:</i></b> The aim of the study was to demonstrate the outcomes of peritoneal dialysis (PD) in critically ill cardiorenal syndrome type 1 (CRS1). <b><i>Methods:</i></b> A cohort of 147 patients with CRS1 who received PD from 2011 to 2019 in a referral hospital in Thailand was analyzed. The primary outcome was 30-day in-hospital mortality. Ultrafiltration and net fluid balance among survivors and nonsurvivors in the first 5 PD sessions were compared. <b><i>Results:</i></b> The 30-day mortality rate was 73.4%. Most patients were critically ill CRS1 (all patients had a respiratory failure of which 68% had cardiogenic shock). Blood urea nitrogen and creatinine at the commencement of PD were 60.1 and 4.05 mg/dL. In multivariable analysis, increasing age, unstable hemodynamics, and positive fluid balance in the first 5 PD sessions were associated with the risk of in-hospital mortality. The change of fluid balance per day during the first 5 dialysis days was significantly different among survivor and nonsurvivor groups (−353 vs. 175 mL per day, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> PD is a viable dialysis option in CRS1, especially in a resource-limited setting. PD can save up to 27% of lives among patients with critically ill CRS1.

scholarly journals Dose–response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039875
Author(s):  
Meiping Wang ◽  
Bo Zhu ◽  
Li Jiang ◽  
Ying Wen ◽  
Bin Du ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Dose Response ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Fluid Overload ◽  
Multivariable Analysis ◽  
Main Diagnosis ◽  
Icu Admission ◽  
Increased Risk

ObjectivesFluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose–response relationship between FO and in-hospital mortality in critically ill patients.DesignMulticentre, prospective, observational study.SettingEighteen intensive care units (ICUs) of 16 tertiary hospitals in China.ParticipantsCritically ill patients in the ICU for more than 3 days.Primary outcome measures and analysesFO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis.ResultsA total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose–response association between maximum FO and in-hospital mortality.ConclusionsBoth higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients.Trial registration numberChiCTR-ECH-13003934.

Abstract #288 Dyslipidemia in Childhood Type 1 Diabetes in India: Prevalence Correlates and Management Challenges in a Resource Limited Setting

2019 ◽  
Vol 25 ◽  
pp. 117
Author(s):  
S Chandraprabha ◽  
T Jayalakshmi ◽  
Reshma Vijay ◽  
Kavitha Muniraj ◽  
Muralidhara Krishna ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Resource Limited Setting ◽  
Resource Limited ◽  
Childhood Type 1 Diabetes ◽  
Childhood Type ◽  
Limited Setting

scholarly journals Acute kidney injury in cardiorenal syndrome type 1: a meta-analysis

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P364
Author(s):  
W Vandenberghe ◽  
S Gevaert ◽  
H Peperstraete ◽  
I Herck ◽  
J Decruyenaere ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Syndrome Type

scholarly journals Oxidative Stress: Dual Pathway Induction in Cardiorenal Syndrome Type 1 Pathogenesis

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Grazia Maria Virzì ◽  
Anna Clementi ◽  
Massimo de Cal ◽  
Alessandra Brocca ◽  
Sonya Day ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Copper Zinc Superoxide Dismutase ◽  
Stress Markers ◽  
Oxidative Stress Pathway ◽  
Significant Augmentation ◽  
Copper Zinc

Cardiorenal Syndrome Type 1 (Type 1) is a specific condition which is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Even though its pathophysiology is complex and not still completely understood, oxidative stress seems to play a pivotal role. In this study, we examined the putative role of oxidative stress in the pathogenesis of CRS Type 1. Twenty-three patients with acute heart failure (AHF) were included in the study. Subsequently, 11 patients who developed AKI due to AHF were classified as CRS Type 1. Quantitative determinations for IL-6, myeloperoxidase (MPO), nitric oxide (NO), copper/zinc superoxide dismutase (Cu/ZnSOD), and endogenous peroxidase activity (EPA) were performed. CRS Type 1 patients displayed significant augmentation in circulating ROS and RNS, as well as expression of IL-6. Quantitative analysis of all oxidative stress markers showed significantly lower oxidative stress levels in controls and AHF compared to CRS Type 1 patients (P<0.05). This pilot study demonstrates the significantly heightened presence of dual oxidative stress pathway induction in CRS Type 1 compared to AHF patients. Our findings indicate that oxidative stress is a potential therapeutic target, as it promotes inflammation by ROS/RNS-linked pathogenesis.

scholarly journals Determinants of Monocyte Apoptosis in Cardiorenal Syndrome Type 1

2018 ◽  
Vol 8 (3) ◽  
pp. 208-216 ◽  
Author(s):  
Andrea Breglia ◽  
Grazia Maria Virzì ◽  
Silvia Pastori ◽  
Alessandra Brocca ◽  
Massimo de Cal ◽  
...  
Keyword(s):  
Gene Expression ◽  
Caspase 3 ◽  
Kidney Injury ◽  
Annexin V ◽  
Cardiorenal Syndrome ◽  
Pathophysiological Mechanism ◽  
Syndrome Type ◽  
Caspase 9 ◽  
Apoptotic Pathway

Background: Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Its pathophysiology is complex and not completely understood. In this study, we examined the role of apoptosis and the caspase pathways involved. Material and Methods: We enrolled 40 acute heart failure (AHF) patients, 11 of whom developed AKI characterizing CRS type 1. We exposed the human cell line U937 to plasma from the CRS type 1 and AHF groups and then we evaluated apoptotic activity by annexin-V evaluation, determination of caspase-3, -8 and -9 levels, and BAX, BAD, and FAS gene expression. Results: We observed significant upregulation of apoptosis in monocytes exposed to CRS type 1 plasma compared to AHF, with increased levels of caspase-3 (p < 0.01), caspase-9 (p < 0.01), and caspase-8 (p < 0.03) showing activation of both intrinsic and extrinsic pathways. Furthermore, monocytes exposed to CRS type 1 plasma had increased gene expression of BAX and BAD (intrinsic pathways) (p = 0.010 for both). Furthermore, strong significant correlations between the caspase-9 levels and BAD and BAX gene expression were observed (Spearman ρ = – 0.76, p = 0.011, and ρ = – 0.72, p = 0.011). Conclusion: CRS type 1 induces dual apoptotic pathway activation in monocytes; the two pathways converged on caspase-3. Many factors may induce activation of both intrinsic and extrinsic apoptotic pathways in CRS type 1 patients, such as upregulation of proinflammatory cytokines and hypoxia/ischemia. Further investigations are necessary to corroborate the present findings, and to better understand the pathophysiological mechanism and consequent therapeutic and prognostic implications for CRS type 1.

scholarly journals SP265ACEI/ARB CAN DECREASE THE RISK OF CARDIORENAL SYNDROME TYPE I AND IN-HOSPITAL MORTALITY

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii467-iii467
Author(s):  
Xu Jiaqi ◽  
Cai Lu ◽  
Liang Xinling ◽  
Du Zhimin ◽  
Chen Yuanhan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiorenal Syndrome ◽  
Type I ◽  
Syndrome Type

scholarly journals Peritoneal Dialysis for Chronic Congestive Heart Failure

2015 ◽  
Vol 40 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Karlien François ◽  
Claudio Ronco ◽  
Joanne M. Bargman
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Clinical Symptoms ◽  
Positive Impact ◽  
Cardiorenal Syndrome ◽  
Current Evidence ◽  
Chronic Congestive Heart Failure ◽  
Syndrome Type ◽  
Fluid Removal

Maladaptive responses between a failing heart and the kidneys ultimately lead to permanent chronic kidney disease, referred to as cardiorenal syndrome type 2. In this narrative review, we discuss the pathophysiological pathways in the progression of cardiorenal failure and review the current evidence on peritoneal dialysis as a treatment strategy in cardiorenal syndrome type 2. A patient with heart failure can present with clinical symptoms related to venous congestion even in the absence of end-stage renal disease. Diuretics remain the cornerstone for the treatment of fluid overload related to heart failure. However, with chronic use, diuretic resistance can supervene. When medical therapy is no longer able to relieve congestive symptoms, ultrafiltration might be needed. Patients with heart failure tolerate well the gentle rate of fluid removal through peritoneal dialysis. Recent publications suggest a positive impact of starting peritoneal dialysis in patients with cardiorenal syndrome type 2 on the hospitalisation rate, functional status and quality of life.

scholarly journals Cardiorenal Syndrome Type 1 May Be Immunologically Mediated: A Pilot Evaluation of Monocyte Apoptosis

2012 ◽  
Vol 2 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Grazia Maria Virzì ◽  
Rossella Torregrossa ◽  
Dinna N. Cruz ◽  
Chang Y. Chionh ◽  
Massimo de Cal ◽  
...  
Keyword(s):  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Monocyte Apoptosis
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