Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss

2018 ◽  
Vol 19 (3) ◽  
pp. 252-257
Author(s):  
Hoon Suk Park ◽  
Joonsung Choi ◽  
Hyung Wook Kim ◽  
Jun Hyun Baik ◽  
Cheol Whee Park ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
De Novo ◽  
Kidney Injury ◽  
Catheter Placement ◽  
Exchange Method ◽  
Hemodialysis Catheter ◽  
Catheter Survival ◽  
Catheter Group ◽  
To Receive ◽  
Tunneled Catheter

Purpose: The exchange from a non-tunneled hemodialysis catheter to a tunneled one over a guidewire using a previous venotomy has been reported to be safe. However, some concerns that it may increase infection risk prevent its clinical application. This approach seems particularly useful for acute kidney injury patients requiring initial renal replacement therapy, in whom we frequently worry about the choice of non-tunneled versus tunneled catheters. Materials and methods: From March 2012 to February 2016, 88 cases to receive the over-the-guidewire exchange method from a non-tunneled to a tunneled catheter and 521 cases to receive de novo tunneled catheter placement from the hemodialysis vascular access cohort were compared retrospectively. Results: The immediate complication, later catheter dysfunction requiring replacement, and infection rates were comparable between the two groups. Newly placed tunneled catheter survival in the over-the-guidewire exchange group was comparable with survival in the de novo tunneled catheter group (p = 0.24). In addition, when we compared the same two methods among only intensive care unit patients; they remained similar (p = 0.19). Conclusion: An exchange with the over-the-guidewire method from a non-tunneled to a tunneled catheter was comparable to a de novo catheter placement technique. Therefore, this method should be viewed more favorably and should especially be considered for acute kidney injury patients.

Pregnancy and the kidney

2021 ◽  
pp. 402-432
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Disease ◽  
De Novo ◽  
Kidney Injury ◽  
Antenatal Clinic ◽  
Medical Complications ◽  
Optimal Timing ◽  
High Incidence ◽  
Preconception Counselling

Renal disease may occur de novo during pregnancy and pregnancy may occur in women with pre-existing renal disease. The chapters in this section consider the causes and implications of acute kidney injury that may occur during pregnancy and the likely outcomes of pregnancy in women with pre-existing chronic kidney disease, including the possible maternal and foetal complications of preterm delivery and pre-eclampsia (PET). There is a high incidence of PET in women with renal disease during pregnancy and importance of diagnosis and safe treatment of hypertension during pregnancy is discussed. The authors present the current theories of the pathogenesis of PET and highlight the importance of prophylactic treatment with aspirin to reduce the risk of PET. Pregnancy is increasingly common following renal transplantation and this group requires special consideration. They may have other concurrent medical conditions that need to be considered during pregnancy, or they may be at higher risk of other medical complications e.g. urinary tract infection with potential implications for maternal health and foetal wellbeing. It is important to facilitate preconception counselling for women with pre-existing renal disease to discuss optimal timing of pregnancy, make necessary adjustments to medications, and to discuss the likely outcomes for mother and baby. Managing renal disease during pregnancy requires the input of nephrologists, obstetricians, midwives, and often other healthcare professionals which is optimally delivered in a multi-disciplinary antenatal clinic with an expertise in this area.

scholarly journals Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

2018 ◽  
Vol 7 (9) ◽  
pp. 248 ◽  
Author(s):  
Chih-Chung Shiao ◽  
Wei-Chih Kan ◽  
Jian-Jhong Wang ◽  
Yu-Feng Lin ◽  
Likwang Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
De Novo ◽  
Kidney Injury ◽  
Control Group ◽  
Research Database ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Recovery Group ◽  
Group Control Group

The influence of acute kidney injury (AKI) on subsequent incident atrial fibrillation (AF) has not yet been fully addressed. This retrospective nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2010. A total of 41,463 patients without a previous AF, mitral valve disease, and hyperthyroidism who developed de novo dialysis-requiring AKI (AKI-D) during their index hospitalization were enrolled. After propensity score matching, “non-recovery group” (n = 2895), “AKI-recovery group” (n = 2895) and “non-AKI group” (control group, n = 5790) were categorized. Within a follow-up period of 6.52 ± 3.88 years (median, 6.87 years), we found that the adjusted risks for subsequent incident AF were increased in both AKI-recovery group (adjusted hazard ratio (aHR) = 1.30; 95% confidence intervals (CI), 1.07–1.58; p ≤ 0.01) and non-recovery group (aHR = 1.62; 95% CI, 1.36–1.94) compared to the non-AKI group. Furthermore, the development of AF carried elevated risks for major adverse cardiac events (aHR = 2.11; 95% CI, 1.83–2.43), ischemic stroke (aHR = 1.33; 95% CI, 1.19–1.49), and all stroke (aHR = 1.28; 95% CI, 1.15–1.43). (all p ≤ 0.001, except otherwise expressed) The authors concluded that AKI-D, even in those who withdrew from temporary dialysis, independently increases the subsequent risk of de novo AF.

scholarly journals Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Claire Rimes-Stigare ◽  
Paolo Frumento ◽  
Matteo Bottai ◽  
Johan Mårtensson ◽  
Claes-Roland Martling ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Renal Impairment ◽  
Critically Ill ◽  
De Novo ◽  
Kidney Injury ◽  
Chronic Renal Impairment ◽  
Long Term Mortality

scholarly journals Haemodynamically Unstable Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis: Outcome in an ICU of Bangladesh

2017 ◽  
Vol 42 (1) ◽  
pp. 14-20
Author(s):  
Kaniz Fatema ◽  
Mohammad Omar Faruq
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
De Novo ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Cost Effective ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Low Efficiency

Acute kidney injury (AKI) is a risk factor for increased mortality in critically ill patients. Sustained low efficiency dialysis (SLED) is a new approach in renal replacement therapy (RRT) and it combines the advantages of continuous renal replacement therapy (CRRT) and intermittent haemodialysis (HD). The study was aimed to evaluate the outcome of the hae-modynamically unstable patients with AKI in Bangladesh who were treated with SLED. So far this is the first reported study on SLED in intensive care unit (ICU) in Bangladesh. This quasi-experimental study was conducted in a 10-bed adult ICU of a tertiary care hospital in Bangladesh from June 2012 to May 2013. A total of 153 sessions of SLED were performed on 43 AKI patients. Mean age of the patients was 60.12 ± 15.57 years with male preponder-ance (67.4% were male). Mean APACHE II score was 26.88 ± 6.25. Fourteen patients (32.55%) had de novo AKI. Twenty nine patients (67.4%) had chronic kidney disease (CKD) with baseline mean serum creatinine 2.56 mg/dl, but did not require any RRT before admis-sion in ICU. After giving SLED, AKI of the study patients were completely resolved in 27.9%. Some forty two percent patients became dialysis dependant and 30.23% patients died. Patients who had AKI on CKD became dialysis dependant more often than the patients with de novo AKI (p <0.01). Mortality rate was significantly higher in patients who were on inotrope support (p= 0.017). Otherwise, there was no relation of 28 day mortality with age, prior renal function and mechanical ventilator requirement (p>0.05). Thus, SLED is an excellent renal replacement therapy for the haemodynamically unstable AKI patients of ICU. It is also cost-effective compared to CRRT.

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

MO420ROLE OF IL-6 ON ACUTE KIDNEY INJURY (AKI) DEVELOPMENT AFTER LIVER TRANSPLANTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francesca Tinti ◽  
Martina Colicchio ◽  
Stefano Ginanni Corradini ◽  
Gianluca Mennini ◽  
Massimo Rossi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Growth Factor ◽  
Reperfusion Injury ◽  
Transforming Growth Factor Beta ◽  
Transforming Growth Factor ◽  
De Novo ◽  
Ischemia Reperfusion ◽  
Kidney Injury ◽  
Liver Graft

Abstract Background and Aims Acute kidney injury (AKI) post-liver transplantation is a frequent complication with an incidence up to 70%, requiring renal replacement therapy in about 25% of transplant patients. AKI in patients with normal renal function is a recognized risk factor (FR) of chronic renal failure (CKD) de novo, associated with a 4.5 times greater mortality at 5 years post-transplant. Pathogenesis of AKI is multifactorial. Beyond the classical pre-transplant risk factors, the hypoxia of the graft and the ischemia-reperfusion injury (IRI) have recently been recognized to exert a pathogenetic role with specific mechanisms. It has been recently demonstrated in experimental setting that ischemic tissues put in place protective mechanisms in response to hypoxia aimed at increasing the release of oxygen with the activation of angiogenesis mediated by the expression of factors induced by hypoxia (HIF)-1-alpha. HIF1-alfa has been shown to promote cell survival under hypoxic conditions by switching metabolism from oxidative to glycolytic, by affecting the production of ATP to prevent excessive mitochondrial generation of reactive oxygen species, by promoting secondary release of vascular endothelial growth factor (VEGF) and transforming growth factor-beta 1 (TGF-ß1), with following activation of inflammatory cytokines responsible for systemic inflammatory response syndrome (SIRS). Tumor necrosis factor-α, IL-1 and IL-6 are the most important cytokines released in IRI and seem to play a pivotal role in the onset of AKI in SIRS and sepsis. The development of AKI after hypoxia/ischemia of the graft, as observed more frequently in the population of recipients from donors after cardiocirculatory death (DCD) compared to donation after brain death (DBD), confirms this pathogenetic mechanism. Aim of the study is to evaluate AKI occurrence among liver transplanted patients and its relationship with IRI and cytokines systemic release. Method Data of 78 patients (62 males, 79.5%) undergone liver transplantation (2007-2011) were retrieved. Results The following clinical investigations were performed: AKI patients demonstrated a progressive increasing of IL-6 after liver transplantation (AKI 34.4-37.8-88.2 ng/ml vs no AKI 30.5-21.6-23.3 ng/ml). Conclusion Patients who experienced greater ischaemia-reperfusion injury of the liver graft developed more frequently AKI. Patients with AKI experienced an increased release and circulation of IL-6, that probably is involved in AKI development with interesting implications in future therapy.

ACUTE KIDNEY INJURY IN PATIENTS WITH PULMONARY ARTERY THROMBOEMBOLIA

2021 ◽  
pp. 36-45
Author(s):  
V.V. Filimonova ◽  
M.V. Menzorov ◽  
A.Yu. Bol'shakova
Keyword(s):  
Acute Kidney Injury ◽  
Pulmonary Artery ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
De Novo ◽  
Central City ◽  
Kidney Injury ◽  
Cardiology Department ◽  
Estimated Risk ◽  
Stage 1

The aim of the study is to diagnose acute kidney injury, its severity, and types in patients with pulmonary artery thromboembolia (PATE), to establish the correlation between AKI and the estimated mortality risk, hospital mortality. Materials and Methods. The study enrolled 111 patients (61 males (55 %), and 50 females (45 %), average age 66.8±11.7 years) with PATE, hospitalized to the cardiology department of Ulyanovsk Central City Clinical Hospital. Results. Acute kidney injury was diagnosed in 36 patients with PATE (34 %): among them 24 patients with stage 1 PATE (67 %); 7 patients with stage 2 (19 %); 5 patients with stage 3 (14 %). Prehospital complications were diagnosed in 20 patients (56 %), hospital AKI was detected in 16 patients (44 %). CKD-associated AKI was observed in 24 patients (67 %), de novo AKI was diagnosed in 12 trial subjects (33 %). Twenty-six patients (23 %) died during hospitalization. The relative hospital mortality risk in AKI patients was 5.2 (95 % CI: 2.02–13.39; p<0.001). The estimated risk of 30-day mortality according to the PESI score was higher in AKI patients (120.0 (87.5–158,0) and 90 (87.5-158.0), respectively, p=0.004). Conclusion. Patients with PATE had a high incidence of AKI, which was diagnosed in every 3rd patient. In 67 % of patients, AKI was associated with chronic kidney disease. Patients with prehospital AKI prevailed (56 %). AKI in patients with PATE was associated with increased in-hospital mortality and an estimated 30-day mortality risk. Keywords: acute kidney injury, pulmonary embolism, hospital mortality, estimated mortality risk. Цель исследования. Оценить наличие, степень выраженности и варианты острого повреждения почек (ОПП) у пациентов с тромбоэмболией легочной артерии (ТЭЛА); уточнить связь между ОПП и расчетным риском смерти, госпитальной летальностью. Материалы и методы. Обследовано 111 пациентов (мужчин – 61 (55 %), женщин – 50 (45 %), средний возраст – 66,8±11,7 года) с ТЭЛА, госпитализированных в отделение кардиологии ГУЗ «Центральная городская клиническая больница г. Ульяновска». Результаты. Острое повреждение почек диагностировано у 36 (34 %) пациентов с ТЭЛА, причем у 24 (67 %) из них выявлена 1 стадия, у 7 (19 %) – 2 стадия и у 5 (14 %) – 3 стадия. У 20 (56 %) пациентов диагностирован догоспитальный вариант осложнения, госпитальное ОПП выявлялось в 16 (44 %) случаях. ОПП при ХБП имело место у 24 (67 %) обследованных, ОПП de novo – у 12 (33 %). В период госпитализации умерло 26 (23 %) пациентов. Относительный риск смерти в стационаре у пациентов с ОПП составил 5,2 (95 % ДИ: 2,02–13,39; р<0,001). Расчетный риск 30-дневной смерти по шкале PESI при наличии ОПП был выше, чем при его отсутствии (120,0 (87,5–158,0) и 90 (87,5–158,0) соответственно, p=0,004). Выводы. У пациентов с ТЭЛА наблюдается высокая частота ОПП, оно диагностируется у каждого 3-го пациента. У 67 % пациентов острое повреждение почек развивается на фоне предшествующей хронической болезни почек. Преобладают пациенты с догоспитальным ОПП (56 %). Острое повреждение почек у пациентов с ТЭЛА ассоциировано с увеличением госпитальной летальности и расчетного риска 30-дневной смертности. Ключевые слова: острое повреждение почек, тромбоэмболия легочной артерии, госпитальная летальность, расчетный риск смерти.

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