Impact of Ivabradine on renal function in septic patient with early renal impairment

Abstract Background Acute kidney injury (AKI) with sepsis increases mortality significantly. The pathophysiology of AKI during sepsis is complex and multifactorial. Lower heart rate is associated with better survival in patients with multiple organ dysfunction syndrome (MODS), a disease mostly caused by sepsis. In our study, we hypnotized that use of ivardrabine as heart rate reducing agent in septic patient with renal impairment may improve renal function. Results Fifty patients with sepsis with early renal impairment were divided in 1: 1 ratio to receive Ivabradine (group I) or not (group C). The average age of the included patients was almost 45 years, chest disorders were the main cause of sepsis in both groups. There were statistically significant differences between both groups in terms of reduction of heart rate group (I) (68.13 ± 3.34) versus (group C) (87.04 ± 3.23) and (P < 0.001) also, improvement in eGFR by Cystatin c in group (I) (103.32 ± 6.96) versus (group C) (96.25 ± 6.36) and (P < 0.001) also vasopressor dosage consumption (P < 0.001). As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (P = 0.390), need for hemodialysis (P = 0.384), and mortality (P = 1.000). Conclusions We concluded that Ivabradine as an adjuvant therapy in septic patients with renal impairment is promising agent to reduce such impairment. Trial registration Pan African Clinical Trial Registry: Identification number for the registry is PACTR201911806644230.

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Colistin Use in Patients with Extreme Renal Function: From Dialysis to Augmented Clearance

Medicina ◽

10.3390/medicina55020033 ◽

2019 ◽

Vol 55 (2) ◽

pp. 33 ◽

Cited By ~ 3

Author(s):

Aleksandra Aitullina ◽

Angelika Krūmiņa ◽

Šimons Svirskis ◽

Santa Purviņa

Keyword(s):

Renal Function ◽

Renal Impairment ◽

Kidney Injury ◽

Multidrug Resistant ◽

Study Data ◽

Gram Negative ◽

Function Impairment ◽

Patient Groups ◽

Functional States ◽

Use Pattern

Background and objectives: Colistin is used for the treatment of multidrug-resistant (MDR) Gram-negative bacteria infection in critically ill patients. It is recommended to adjust the dose in cases of renal impairment but not in cases of augmented renal clearance (ARC). The aim of this study was to determine colistin use pattern in patients with different renal functional states. Materials and Methods: Adult patients admitted to intensive care units of single Latvian hospitals in the years 2015–2017 with an MDR Gram-negative bacterial infection and at least 72 h colistin therapy were included in this study. Data were collected retrospectively from medical notes. Colistin use pattern and outcomes were analyzed in patients with different renal function prior to colistin therapy: normal, ARC, impaired, and on renal replacement therapy (RRT). Results: 100 cases of colistin use met the inclusion criteria. The study group was heterogeneous, and patients had different renal function states prior to colistin therapy-from continuous RRT (18 cases) to ARC (16 cases). The standard colistin dose of 9 million units (MU) daily was the most common dose among the patients. In many cases (43%), colistin dose adjustment did not follow the recent recommendations of drug manufacturers-this was mainly in patients with renal impairment prior to colistin therapy. Eighteen cases of colistin acute kidney injury (AKI) were detected, mostly (10 cases) in patients with normal renal function and without ARC prior to colistin therapy. No patients with colistin AKI needed RRT. Conclusions: Colistin doses varied greatly among patients, and in patients with renal function impairment it was commonly not in accordance with the summary of product characteristics (SPC). Patients with ARC mostly received a standard colistin daily dose of 9 MU daily, but the cumulative dose had a tendency to be higher and duration of colistin therapy was longer in comparison with other patient groups. ARC’s role in the development of colistin nephrotoxicity is still unclear.

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Cholemic Nephropathy: Hyperbilirubinemia and its Impact on Renal Function

Journal of Renal and Hepatic Disorders ◽

10.15586/jrenhep.2019.52 ◽

2019 ◽

Vol 3 (1) ◽

pp. 33-39 ◽

Cited By ~ 1

Author(s):

Jonathan S Chávez-Iñiguez ◽

Alejandra Meza-Ríos ◽

Arturo Santos-Garcia ◽

Guillermo García-García ◽

Juan Armendáriz-Borunda

Keyword(s):

Renal Function ◽

Liver Disease ◽

Renal Impairment ◽

Current Knowledge ◽

Treatment Strategies ◽

Kidney Injury ◽

Renal Tissue ◽

Severe Liver Dysfunction ◽

Proximal Tubulopathy ◽

End Stage

Cholemic nephropathy represents a spectrum of renal injury, from proximal tubulopathy to intrarenal bile cast formation, found in patients with severe liver dysfunction. It is caused by hyperbilirubinemia, usually in jaundiced patients. Acute kidney injury is one of the most important complications in patients with end-stage liver disease. The relationship between liver disease and renal impairment, especially the effect of hyperbilirubinemia on renal tissue and renal function, has not been fully elucidated. These considerations deem necessary for nephrologists, when performing a clinical evaluation of patients with liver diseases, for the implementation of an integrated medical approach. This review focuses on the current knowledge on cholemic nephropathy with emphasis on the role of hyperbilirubinemia on renal impairment. The treatment strategies and outcome are also discussed.

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Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Critical Care Research and Practice ◽

10.1155/2020/2170828 ◽

2020 ◽

Vol 2020 ◽

pp. 1-19

Author(s):

Seechad Noonpradej ◽

Osaree Akaraborworn

Keyword(s):

Systematic Review ◽

Renal Function ◽

Abdominal Surgery ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Volume Effect ◽

Intravenous Fluid ◽

Major Abdominal Surgery ◽

Intravascular Volume ◽

Hemodynamic Status

Background. Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. Since the most suitable type of fluid is debatable, a consensus in perioperative patients has not been reached. Method. We performed a systematic review of randomized control trials (RCTs) that compared two or more types of fluids in major abdominal surgery. The outcomes were related to bleeding, hemodynamic status, length of hospital stay, and complications, such as kidney injury, electrolyte abnormality, major cardiac adverse event, nausea, vomiting, and mortality. A literature search was performed using Medline and EMBASE up to December 2019. The data were pooled to investigate the effect of fluid on macrocirculation and intravascular volume effect. Results. Forty-three RCTs were included. Eighteen fluids were compared: nine were crystalloids and nine were colloids. The results were categorized into macrocirculation and intravascular volume effect, microcirculation, anti-inflammatory parameters, vascular permeability, renal function (colloids), renal function and electrolytes (crystalloids), coagulation and bleeding, return of bowel function, and postoperative nausea vomiting (PONV). We found that no specific type of fluid led to mortality and every type of colloid was equivalent in volume expansion and did not cause kidney injury. However, hydroxyethyl starch and dextran may lead to increased bleeding. Normal saline can cause kidney injury which can lead to renal replacement therapy, and dextrose fluid can decrease PONV. Conclusion. In our opinion, it is safe to give a balanced crystalloid as the maintenance fluid and give a colloid, such as HES130/0.4, 4% gelatin, or human albumin, as a volume expander.

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Acute Kidney Injury Following Star Fruit (Averrhoa carambola) Ingestion in a Previously Healthy Young Man

Journal of Medicine ◽

10.3329/jom.v19i1.34846 ◽

2017 ◽

Vol 19 (1) ◽

pp. 63-65 ◽

Cited By ~ 1

Author(s):

Abdul Mumith Ruhan ◽

Parash Ullah ◽

Md Moyeen Uddin ◽

MM Jahangir Alam ◽

Md Shafiqul Bari ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Impairment ◽

Normal Renal Function ◽

Kidney Injury ◽

Averrhoa Carambola ◽

Star Fruit ◽

Patient’S History ◽

Oxalate Nephropathy

Star fruit (Averrhoa carambola) is a commonly available and popular fruit in many tropical and subtropical countries. Although star fruit induced oxalate nephropathy in patients with pre-existing renal impairment is well documented, reports on its effect on those with normal renal function are infrequent. Hereby we report a case where a young man with previously normal renal function presented with AKI that was attributable to consumption of star fruit. This write up illustrates the importance of obtaining the patient’s history with respect to ingestion of star fruit in case of sudden and unexplained development of renal impairment.J MEDICINE Jan 2018; 19 (1) : 63-65

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Renal Functional Reserve Is Related to the Nondipping Phenotype and to the Exercise Heart Rate Response in Patients with Essential Hypertension and Preserved Renal Function

Kidney & Blood Pressure Research ◽

10.1159/000508939 ◽

2020 ◽

Vol 45 (5) ◽

pp. 737-747

Author(s):

Katerina Damianaki ◽

Michel Burnier ◽

Kyriakos Dimitriadis ◽

Costas Tsioufis ◽

Dimitrios Petras

Keyword(s):

Heart Rate ◽

Renal Function ◽

Essential Hypertension ◽

Vascular Reactivity ◽

Stress Test ◽

Kidney Injury ◽

Exercise Heart Rate ◽

Functional Reserve ◽

Hypertensive Patients ◽

Renal Functional Reserve

Background: Renal functional reserve (RFR), defined as the difference between stress and resting glomerular filtration rate (GFR), may constitute a diagnostic tool to identify patients at higher risk of developing acute kidney injury or chronic kidney disease. Blunted RFR has been demonstrated in early stages of hypertension and has been attributed to impaired vascular reactivity due to an overactive sympathetic nervous system (SNS). Objective: The purpose of this study was to investigate whether RFR correlates with other phenotypes expressing overactivity of the SNS in patients with essential hypertension and preserved renal function. Methods: Thirty-six patients with untreated essential hypertension and a GFR >60 mL/min/1.73 m2 were enrolled. The following parameters were measured: RFR, 24-h ambulatory blood pressure (BP) profile, a treadmill stress test, and an echocardiographic examination. Urine and venous samples were obtained at specific time points for the determination of clinical parameters, and both resting and stress GFR were calculated by using endogenous creatinine clearance for the measurement of RFR after an acute oral protein load (1 g/kg). Results: Twenty-one patients had a RFR <30 mL/min/1.73 m2 and 15 had a RFR above this cutoff. A nondipping pattern of 24-h BP was significantly more frequent in patients with low RFR (57.1 vs. 25.0%, p < 0.05 for systolic BP and 52.3 vs. 10.0%, p < 0.02 for diastolic BP). Moreover, patients with lower RFR values showed a blunted heart rate (HR) response to exercise during treadmill test (r = 0.439, p < 0.05). None of the echocardiographic parameters differed between the two groups of patients. Conclusions: In hypertensive patients with preserved GFR, reduced RFR is related to nondipping BP phenotype as well as to attenuated exercise HR response. Overactivity of the SNS may be a common pathway. Since loss of RFR may represent a risk factor for acute or chronic kidney injury, hypertensive patients with blunted RFR might need a more careful renal follow-up.

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Renal Function in Critically Ill Patients

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0005 ◽

2019 ◽

pp. 35-41

Author(s):

Pramod K. Guru

Keyword(s):

Renal Function ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Multiple Organ ◽

Organ System ◽

Organ System Failure ◽

Renal Changes ◽

Multiple Organ System Failure ◽

Essential Knowledge

Renal function serves as a window into the homeostasis of internal organs, and multiple organ system failure can occur in critically ill patients irrespective of the initial site of insult. Therefore, essential knowledge of renal pathophysiology is crucial in the diagnostic approach and management of critically ill patients. Close interaction between the kidney and other vital organs such as the heart, lungs, and brain is primarily responsible for the morbidity and mortality among critically ill patients. Pathologic renal changes can manifest in various conditions, such as acute kidney injury (AKI), chronic kidney disease, glomerulonephritis, fluid-electrolyte imbalances, and nephrotic syndrome.

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Atypical hemolytic-uremic syndrome as one of the causes of acute kidney injury in pregnant women

Terapevticheskii arkhiv ◽

10.26442/terarkh201890628-34 ◽

2018 ◽

Vol 90 (6) ◽

pp. 28-34 ◽

Cited By ~ 1

Author(s):

N L Kozlovskaya ◽

Yu V Korotchaeva ◽

E M Shifman ◽

L A Bobrova

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Hemolytic Uremic Syndrome ◽

Atypical Hemolytic Uremic Syndrome ◽

Clinical Manifestations ◽

Kidney Injury ◽

Complete Recovery ◽

Multiple Organ ◽

Aim Analysis ◽

Uremic Syndrome

Obstetric atypical hemolytic uremic syndrome (aHUS) is one of the reasons for the development of acute kidney injury (AKI) and can determine the prognosis of both mother and child. Aim. Analysis of clinical manifestations, course and outcomes of obstetric aHUS. Materials and methods. 45 patients with aHUS development during pregnancy or immediately after childbirth were observed between 2011 and 2017, age from 16 to 42 years. Results and discussion. All patients had AKI (serum creatinine 521,5±388,0 µmol/l, oliguria or anuria that required initiation of hemodialysis). 93.3% pts had extrarenal manifestations of TMA with the development of multiple organ failure (MOF). The mean number of damage organs was 3,7±1,2. In all patients, the development of aHUS was preceded by obstetric complications, surgery, infection, etc. In the outcome: 53.4% women showed complete recovery of renal function, 11.1% developed CKD 4-5 stages, 35.5% had dialysis-dependent end-stage renal failure (ESDR). Maternal mortality was 23.9%. Perinatal mortality was 32.6%. The early start of eculizumab treatment (within 1-2 weeks from the onset of aHUS), compared with therapy start after 3 weeks, increased the chances of favorable outcome for mother in 5.33 times, and the chances for normalization of renal function in 48.7 times. Conclusion. Obstetric aHUS is characterized by the development of AKI in 100% of cases. In most patients, the obstetric aHUS occurs with the development of MOF. Timely diagnosis of aHUS and immediate treatment by eculizumab allows not only to save the life of patients, but also completely restore their health.

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Rhabdomyolysis-associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis

10.21203/rs.3.rs-40084/v1 ◽

2020 ◽

Author(s):

Decai Zhu ◽

Wenyan Li ◽

Jiawen Zhang ◽

Junsheng Tong ◽

Wenyuan Xie ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Clinical Characteristics ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Icu Transfer ◽

Icu Treatment

Abstract Background: Rhabdomyolysis (RM) associated acute kidney injury (AKI) is the most common systemic complication of RM. The present study aimed to assess the clinical characteristics and risk factors for intensive care unit (ICU) transfer for patients with RM-associated AKI.Methods: We included all patients who were age ≥ 18 years old with a diagnosis of RM from September 2012 to October 2018 and divided them into RM-associated AKI group and RM without AKI group. The primary outcome was transferring to ICU treatment. Regression analysis was performed to identify factors associated with ICU treatment and recovery of renal function.Results: Among the 149 patients with RM, 68 (45.6%) developed AKI. The percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% versus 12.3%, P < 0.002). Additionally, patients with AKI had higher percentage of undergoing dialysis (19.1% versus 2.5%, P < 0.01), all-cause mortality (13.2% versus 1.2%, P < 0.01), cost of hospitalization [10.8 1,000 yuan, IQR (5.5, 3.5) versus 5.9 1,000 yuan, IQR 5.9 (3.6, 9.9), P = 0.03], as well as longer length of hospital stay [8.0 (5.0, 14.0)] versus [6.0 (4.0, 11.0)], P = 0.02). Moreover, most patients with AKI achieved complete recovery (77.9%) at discharge. After adjusting for potential risk factors, RM-associated AKI remained an independent risk factor for ICU transfer (OR = 3.0, 95% CI, 1.11–8.3, P = 0.03). However, ICU transfer was not associated with recovery of renal function (OR = 0.88, 95% CI, 0.22–3.57, P = 0.856).Conclusion: RM leaded to AKI in most patients. RM-associated AKI could cause worse clinical outcome and predict ICU transfer for patients with RM.

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The effects of 0.9% saline versus Plasma-Lyte 148 on renal function as assessed by creatinine concentration in patients undergoing major surgery: A single-centre double-blinded cluster crossover trial

PLoS ONE ◽

10.1371/journal.pone.0251718 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251718

Author(s):

Laurence Weinberg ◽

Michael Hua-Gen Li ◽

Leonid Churilov ◽

Christopher Macgregor ◽

Kent Garrett ◽

...

Keyword(s):

Renal Function ◽

Crossover Trial ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Trial Registration ◽

Major Surgery ◽

Serious Adverse Events ◽

Creatinine Concentration ◽

Double Blinded ◽

Postoperative Aki

Objectives Saline and Plasma-Lyte have different physiochemical contents; consequently, they may differently affect patients’ renal function. We compared the effects of fluid therapy with 0.9% saline and with Plasma-Lyte 148 on renal function as assessed by creatinine concentration among patients undergoing major surgery. Methods We conducted a prospective, double-blinded cluster crossover trial comparing the effects of the two fluids on major surgery patients. The primary aim was to establish the pilot feasibility, safety and preliminary efficacy evidence base for a large interventional trial to establish whether saline or Plasma-Lyte is the preferred crystalloid fluid for managing major surgery patients. The primary efficacy outcome was the proportion of patients with changes in renal function as assessed by creatinine concentration during their index hospital admission. We used changes in creatinine to define acute kidney injury (AKI) according to the RIFLE criteria. Results The study was feasible with 100% patient and clinician acceptance. There were no deviations from the trial protocol. After screening, we allocated 602 patients to saline and 458 to Plasma-Lyte. The median (IQR) volume of intraoperative fluid received was 2000 mL (1000:2000) in both groups. Forty-nine saline patients (8.1%) and 49 Plasma-Lyte patients (10.7%) developed a postoperative AKI (adjusted incidence rate ratio [aIRR]: 1.34; 95% CI: 0.93–1.95; p = 0.120). No differences were observed in the development of postoperative complications (aIRR: 0.98; 95% CI: 0.89–1.08) or the severity of the worst complication (aIRR: 1.00; 95% CI: 0.78–1.30). The median (IQR) length of hospital stay was six days (3:11) for the saline group and five days (3:10) for the Plasma-Lyte group (aIRR: 0.85; 95% CI: 0.73–0.98). There were no serious adverse events relating to the trial fluids, nor were there fluid crossover or contamination events. Conclusions The study design was feasible to support a future follow-up larger clinical trial. Patients treated with saline did not demonstrate an increased incidence of postoperative AKI (defined as changes in creatinine) compared to those treated with Plasma-Lyte. Our findings imply that clinicians can reasonably use either solution intraoperatively for adult patients undergoing major surgery. Trial registration Registry: Australian New Zealand Clinical Trials Registry; ACTRN12613001042730; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364988.

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Incidence and impact of acute cardiorenal syndrome

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.020 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

C Mantis ◽

I Vasiliadis ◽

A Anadiotis ◽

E Papadakis ◽

S Patsilinakos

Keyword(s):

Heart Failure ◽

Renal Function ◽

Acute Heart Failure ◽

Ischemic Cardiomyopathy ◽

Strong Predictor ◽

Statistical Significance ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Aldosterone Antagonists ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute (or type 1) cardio-renal syndrome (ACRS) is defined as the acute kidney injury in patients hospitalized for acute heart failure (HF), which often is associated to a complex and complicated clinical course. In addition, renal failure is a strong predictor of long-term adverse events in patients with acute heart failure (HF). Purpose To investigate the impact of ACRS, what factors are related to its occurrence, and how it affects the outcome of patients hospitalized with acute HF. Methods We studied consecutive patients hospitalized with acute HF from January 2019 to December 2020. Renal function as well as other biomarkers were recorded and monitored during hospitalization, and correlated with various clinical characteristics, risk factors and patient outcome. Results The sample consists of 612 patients, mean age 77 ± 12 years, 63% men with average duration of hospitalization 6 ± 4 days. A total of 37 deaths (6%) were observed. ACRS was found in 141 patients (23%) and independent prognostic factors for its occurrence were ischemic cardiomyopathy, age, prolonged hospitalization, use of aldosterone antagonists and high CRP upon admission. The incidence of ACRS during hospitalization was an independent prognostic factor of death (r = 0.15, p = 0.02) and anemia (r = 0.24, p = 0.04), while the outcome of death was more common in patients with ACRS - but without statistical significance - compared to patients without ACRS. Conclusion Deterioration of renal function in acute HF is associated with anemia and death. Factors such as ischemic cardiomyopathy, age, length of hospital stay seem to play a role in the onset of ACRS and should be taken into account in these patients, to prevent negative outcomes.

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