scholarly journals Impact of Comorbidities on Beneficial Effect of Lactated Ringers Versus Saline in Sepsis Patients

2021 ◽  
Author(s):  
Chien Hua Tseng ◽  
Tzu-Tao Chen ◽  
Ming-Cheng Chan ◽  
Kuan Yuan Chen ◽  
Sheng Ming Wu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Liver Disease ◽  
Kidney Disease ◽  
Chronic Liver Disease ◽  
Saline Group ◽  
Serum Lactate ◽  
Chronic Pulmonary Disease ◽  
Fluid Type ◽  
Central Venous ◽  
Cerebral Vascular Disease

Abstract Background: Lactated Ringers reduced mortality more than saline in sepsis patients but increased mortality more than saline in traumatic brain injury patients. Method: This prospective cohort study included sepsis patients and identified heart, lung, liver, kidney, and endocrine comorbidities by detailed history taking and routine admission survey such as HbA1C, and liver functions. We evaluate resuscitation response with central venous pressure, central venous oxygen saturation, and serum lactate level simultaneously. Propensity-score matching and Cox regression were used to estimate 60-day mortality. The competing risk model compared the lengths of hospital and ICU stays with the subdistribution hazard ratio (SHR). Mixed-effect linear models were used to fit clinical variables and electrolyte trends.Results: Overall, 874 patients were included in the analysis; 636 patients were in the saline group, and 302 patients were in the lactated Ringers group. The lactated Ringers group had a lower mortality rate (adjusted hazard ratio, 0.59; 95% CI 0.43-0.81) and shorter lengths of hospital (SHR, 1.39; 95% C.I. 1.15-1.67) and ICU stays (SHR, 1.41; 95% CI 1.17, 1.71) than the saline group; the differences were greater in patients with chronic pulmonary disease and small and nonsignificant in those with chronic kidney disease, moderate to severe liver disease and cerebral vascular disease. The resuscitation efficacy was the same between fluid types, but serum lactate levels were significantly higher in the lactated Ringers group than in the saline group (0.12 mg/dL/hour; 95% C.I.: 0.03, 0.21), especially in chronic liver disease patients receiving lactated Ringers. The serum potassium level increased within the first few hours and recovered more slowly in patients with chronic kidney disease regardless of fluid type. Compared to the saline group, the lactated Ringers group achieved target glucose level earlier in both diabetes and non-diabetes patients.Conclusion: Patients receiving lactated Ringers had lower mortality and shorter lengths of hospital and ICU stays than those receiving saline, especially patients with chronic pulmonary disease, but there were no differences in those with chronic kidney disease, chronic liver disease and cerebral vascular disease. Comorbidities are important for clinicians to consider before choosing a fluid type.

scholarly journals Impact of Comorbidities on Beneficial Effect of Lactated Ringers vs. Saline in Sepsis Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Ming-Cheng Chan ◽  
Kuan-Yuan Chen ◽  
Sheng-Ming Wu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Liver Disease ◽  
Kidney Disease ◽  
Pulmonary Disease ◽  
Saline Group ◽  
Serum Lactate ◽  
Chronic Pulmonary Disease ◽  
Central Venous ◽  
Severe Liver ◽  
Severe Liver Disease

Background: Lactated Ringers reduced mortality more than saline in sepsis patients but increased mortality more than saline in traumatic brain injury patients.Method: This prospective cohort study was conducted in a medical intensive care unit (ICU) in central Taiwan. We applied standard sepsis evaluation protocol and identified heart, lung, liver, kidney, and endocrine comorbidities. We also evaluated resuscitation response with central venous pressure, central venous oxygen saturation, and serum lactate level simultaneously. Propensity-score matching and Cox regression were used to estimate mortality. The competing risk model compared the lengths of hospital stays with the subdistribution hazard ratio (SHR).Results: Overall, 938 patients were included in the analysis. The lactated Ringers group had a lower mortality rate (adjusted hazard ratio, 0.59; 95% CI 0.43-0.81) and shorter lengths of hospital stay (SHR, 1.39; 95% C.I. 1.15-1.67) than the saline group; the differences were greater in patients with chronic pulmonary disease and small and non-significant in those with chronic kidney disease, moderate to severe liver disease and cerebral vascular disease. The resuscitation efficacy was the same between fluid types, but serum lactate levels were significantly higher in the lactated Ringers group than in the saline group (0.12 mg/dl/h; 95% C.I.: 0.03, 0.21), especially in chronic liver disease patients. Compared to the saline group, the lactated Ringers group achieved target glucose level earlier in both diabetes and non-diabetes patients.Conclusion: Lactate Ringer's solution provides greater benefits to patients with chronic pulmonary disease than to those with chronic kidney disease, or with moderate to severe liver disease. Comorbidities are important in choosing resuscitation fluid types.

Diuretics in critical illness

2016 ◽  
Author(s):  
Marlies Ostermann ◽  
Ruth Y. Y. Wan
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Liver Disease ◽  
Kidney Disease ◽  
Chronic Liver Disease ◽  
Fluid Overload ◽  
Chronic Liver ◽  
Risk Of Death

Fluid overload and chronic hypertension are the most common indications for diuretics. The diuretic response varies between different types and depends on underlying renal function. In patients with congestive heart failure, diuretics appear to reduce the risk of death and worsening heart failure compared with placebo, but their use in acute decompensated heart failure is questionable. Diuretics are also widely used in chronic kidney disease to prevent or control fluid overload, and treat hypertension. In acute kidney injury, there is no evidence that they improve renal function, speed up recovery, or change mortality. In patients with chronic liver disease and large volume ascites, paracentesis is more effective and associated with fewer adverse events than diuretic therapy, but maintenance treatment with diuretics is indicated to prevent recurrence of ascites. Mannitol has a role in liver patients with cerebral oedema and normal renal function. The use of diuretics in rhabdomyolysis is controversial and restricted to patients who are not fluid deplete. In conditions associated with resistant oedema (chronic kidney disease, congestive heart failure, chronic liver disease), combinations of diuretics with different modes of action may be necessary. Diuresis is easier to achieve with a continuous furosemide infusion compared with intermittent boluses, but there is no evidence of better outcomes. The role of combination therapy with albumin in patients with fluid overload and severe hypoalbuminaemia is uncertain with conflicting data.

scholarly journals Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease

2017 ◽  
Vol 166 (3) ◽  
pp. 191 ◽  
Author(s):  
Matthew J. Crowley ◽  
Clarissa J. Diamantidis ◽  
Jennifer R. McDuffie ◽  
C. Blake Cameron ◽  
John W. Stanifer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Liver Disease ◽  
Kidney Disease ◽  
Chronic Liver Disease ◽  
Clinical Outcomes ◽  
Chronic Liver

scholarly journals Nonalcoholic Fatty Liver Disease-Related Chronic Kidney Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Camelia Cojocariu ◽  
Ana-Maria Singeap ◽  
Irina Girleanu ◽  
Stefan Chiriac ◽  
Cristina M. Muzica ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Liver Disease ◽  
Kidney Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Chronic Liver Disease ◽  
Fatty Liver Disease ◽  
Chronic Liver ◽  
Major Health Problem ◽  
Nonalcoholic Fatty Liver

Nonalcoholic fatty liver disease has become the main concern of hepatologists around the world and the main research topic for identifying effective and safe therapy. Advances in the treatment of chronic viral hepatitis in recent years have opened the way towards reducing mortality in patients with chronic liver disease. This goal has not yet been reached, as the burden of chronic liver disease remains a future major health problem as the incidence of the nonalcoholic fatty liver disease continues to rise. The proportion of patients with liver cirrhosis and those with hepatocellular carcinoma due to nonalcoholic liver disease on the liver transplant waiting list has increased in the last years. The upward trend in the incidence and prevalence of the disease in recent decades raises concern over a possible global epidemic, especially as the disease is still underestimated and underdiagnosed. Chronic kidney disease presented an increase in incidence and prevalence during the last years, and it has been associated not only with increased morbidity and mortality but also with high costs for the health system. During the last decade, several studies have shown the association between nonalcoholic fatty disease and chronic kidney disease, two major worldwide health problems.

scholarly journals Chronic Kidney Disease – Chronic Liver Disease. An Immunologic Cross-talk

2015 ◽  
Vol 53 (1) ◽  
pp. 3-12
Author(s):  
Gh. Gluhovschi ◽  
Ligia Petrica ◽  
I. Sporea ◽  
Manuela Curescu ◽  
Silvia Velciov ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Immune System ◽  
Liver Disease ◽  
Kidney Disease ◽  
Chronic Liver Disease ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Immune Mechanisms ◽  
The Relationship

Abstract The relationship between the kidney and other organs is notable. The bestknown is the relation with the cardiovascular system. Relationships with other organs are less studied, although their involvement sometimes dominates the clinical picture and the outcome of disease. The paper analyzes the kidney-liver relationship, namely chronic kidney disease and chronic liver disease from an immune viewpoint. The immune system operates as a unitary whole. There is an interdependence between the immune system of the liver, considered a lymphoid organ, and the kidney, whose participation in immune processes is well-known. The most important chronic liver diseases are viral hepatitis B and C. Infection with these viruses can lead to renal involvement, producing mainly glomerular disease. At the same time, secondary glomerulonephritis can cause an unfavorable outcome of the primary disease. The relationship between chronic liver disease and chronic kidney disease during chronic B and C hepatitis occurs via circulating immune complexes or complexes formed in situ. Cell-mediated immunity is also involved. The antiviral treatment of B and C hepatitis is also aimed at secondary glomerular disease. The participation of immune mechanisms raises the question of administering immunomodulating medication, a type of medication that influences viral replication - this is why it is associated with antiviral medication. Other two chronic liver diseases, namely liver cirrhosis, in which the main mechanism is a toxic one, and non-alcoholic steatohepatitis can produce via immune mechanisms glomerular involvement. In its turn, chronic kidney disease in advanced stages causes lipid metabolism disturbances with hypertriglyceridemia, which can influence fatty loading of the liver in the above-mentioned liver diseases. One can speak about a cross-talk between the liver and the kidney, in which immune mechanisms play an important role.

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