Abstract:
BACKGROUND:Critically ill patients with acute kidney injury (AKI) are at high risk for death and frequently require initiation of renal replacement therapy (RRT). There is wide variation in clinical practice on the indications for and timing of initiation and discontinuation of RRT. Numerous clinical and biochemical factors (i.e. uremic, metabolic, fluid balance) have been used; however, at present there is no consensus to guide clinicians on the most favorable time to initiate and/or discontinue RRT to optimize patient outcomes. METHODS:In this review, we appraise the available clinical studies that have assessed timing of initiation and/or discontinuation of RRT for critically ill patients with AKI. 'Timing' of initiation has been variably defined including use of conventional biomarkers (i.e. serum urea and creatinine), urine output, fluid balance, and time relative to intensive care unit admission. CONCLUSIONS:Numerous studies consistently point toward a survival benefit to early initiation of RRT; however, there is a paucity of high-quality randomized trials. If early RRT is associated with clinical benefit, it remains uncertain whether this is attributable to more rapid metabolic/uremic control, management of fluid balance or a combination of clinical factors. In addition, timing of RRT initiation is likely context-specific and varies by clinical factors and/or etiology of AKI. There is also little data to accurately distinguish in advance between the injured kidney that will need extracorporeal renal support and one that retains capacity for early recovery. Fewer studies have evaluated the process of weaning of RRT or ideal methods to predict sufficient recovery to avoid re-initiation. Longer duration of RRT support, higher illness severity and lower urine output (independent of diuretic therapy) have all predicted need for re-initiation. Additional investigations on these issues are clearly warranted and urgently needed.
journal_name
Blood Purifjournal_title
Blood purificationauthors
Gibney RT,Bagshaw SM,Kutsogiannis DJ,Johnston Cdoi
10.1159/000157325subject
Has Abstractpub_date
2008-01-01 00:00:00pages
473-84issue
5eissn
0253-5068issn
1421-9735pii
000157325journal_volume
26pub_type
杂志文章,评审abstract::We report the clinical course of 29 patients with Wegener's granulomatosis (WG) treated with plasma exchange (PE) in Norway in the period from 1988 to 1999. Median follow-up was 41.5 months. The mean number of exchanges was 8.5 +/- 5.8 (range 2-32). Median serum creatinine concentration was 400 micromol/l (range 90-1,...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000047004
更新日期:2002-01-01 00:00:00
abstract::We conducted a prospective randomized controlled study to confirm our earlier observation that prolonged subcutaneous implantation of peritoneal catheter reduced peritonitis rate when compared to retrospective data from patients with catheters placed by conventional access technique. A total of 60 patients were random...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000014331
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. SUMMARY:The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic infla...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000494583
更新日期:2019-01-01 00:00:00
abstract:AIMS:The aim of the study was to clarify the relationship between serum ferritin and infectious risks. METHODS:We evaluated all hospital admissions due to infections, clinical biomarkers and nutrition status in 129 incident Japanese dialysis patients during a median follow-up of 38 months. RESULTS:Kaplan-Meier analys...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000445424
更新日期:2016-01-01 00:00:00
abstract::One of the main problems in low protein diet is patient's noncompliance and the risk of both depression and reduced quality of life. A pilot study investigated the life-style and the state of mood before and during low protein diet. The results show a deterioration in the life-style and the state of mood. Conclusions ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169572
更新日期:1989-01-01 00:00:00
abstract:AIMS:To assess whether kidney transplantation improves sleep-related breathing disorders associated with hemodialysis. METHODS:A prospective study was carried out using full-night polysomnography. Nine hemodialysis patients (7 men and 2 women, aged 42 +/- 16.2 years, BMI 26 +/- 3.7) who later received a successful kid...
journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000157373
更新日期:2008-01-01 00:00:00
abstract:AIMS:To improve the side effects caused by sodium citrate (Na(3)Cit), the anticoagulant effects of diethyl citrate (Et(2)Cit) were investigated. METHODS:The in vitro anticoagulant effects and dissociation capacity of the chelate of Et(2)Cit with calcium ions were compared with those of Na(3)Cit in rabbits. RESULTS:Th...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000330891
更新日期:2012-01-01 00:00:00
abstract::The greatest benefit of PD ist the continuous maintenance of a stable electrolyte and acid-base balance, as well as a continuous solute, sodium and water removal. Moreover, PD is effective in preserving residual renal function (RRF). However, when RRF declines, complications will occur if not compensated for by an inc...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000081871
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Asymmetric dimethylarginine (ADMA) levels are increased in hemodialysis (HD) patients. Reports on the effect of various dialysis strategies on ADMA, symmetric dimethylarginine (SDMA) and L-arginine levels are inconclusive. PATIENTS/METHODS:In this randomized crossover study, 15 patients were dialyzed for 4 ...
journal_title:Blood purification
pub_type: 杂志文章,随机对照试验
doi:10.1159/000104868
更新日期:2007-01-01 00:00:00
abstract::A review is given of the conditions associated with peritoneal membrane failure, and the possible causes. Ultrafiltration failure is the most important manifestation. It is mostly associated with high transport rates of low molecular weight solutes suggesting the presence of a large vascular surface area. Enlargement ...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000065202
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Dyslipidemia is a common metabolic complication in patients with chronic kidney disease and is detected as changes in lipoprotein concentrations in serum. SUMMARY:Recently, other features of lipid abnormalities have been described, such as alterations in serum n-3 polyunsaturated fatty acids, cholesterol me...
journal_title:Blood purification
pub_type: 评论,杂志文章
doi:10.1159/000441581
更新日期:2015-01-01 00:00:00
abstract::Heart failure (HF) is a chronic disease process associated with significant morbidity and mortality. Hospitalizations for acute decompensation may be frequent and herald a downward trajectory for the underlying disease state and overall poor prognosis for the patient. While significant advances have been made in the r...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000110558
更新日期:2008-01-01 00:00:00
abstract::The present working hypothesis regarding adequacy issues in peritoneal dialysis is that dialysis is a major determinant of protein intake and therefore nutritional status in these patients. Present data however is controversial. This is in part due to differences in methodology and the calculations used for the data p...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000170201
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:Dialysis patients have higher cardiovascular events rate than patients with normal renal function. Hyperhomocysteinemia, a risk factor for cardiovascular disease, is frequently detected in dialysis patients. Vitamin B supplementation lowers hyperhomocysteinemia, but it is unknown whether it reduces cardiovas...
journal_title:Blood purification
pub_type: 杂志文章,随机对照试验
doi:10.1159/000093680
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:The mortality rate of peritoneal dialysis (PD) patients is still high and controversies persist regarding the mortality predictor. This study was designed to identify the predictability of the extracellular water/intracellular water ratio (E/I) on mortality in PD patients. METHODS:227 incident PD patients w...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000101699
更新日期:2007-01-01 00:00:00
abstract:INTRODUCTION:Glycated hemoglobin is used to assess diabetic control although its accuracy in dialysis has been questioned. How does it compare to the Continuous Glucose Monitoring System (CGMS) in peritoneal dialysis (PD) patients? METHODS:We conducted a retrospective analysis of 60 insulin-treated diabetic patients o...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000439242
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:We explored whether biocompatible dialyzer membranes modulate the inflammatory response during blood contact in patients with systemic inflammation. METHODS:15 patients with end-stage renal disease and systemic inflammation (mean serum C-reactive protein 86 +/- 4 mg/l) were randomly treated with Cuprophan (...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000083941
更新日期:2005-01-01 00:00:00
abstract::Bactericidal/permeability-increasing protein (BPI) is a natural constituent of human neutrophils. Recombinant BPI has been shown to bind to bacterial lipopolysaccharide (LPS), and to neutralize the ability of LPS to stimulate inflammatory cells in vitro and in vivo. BPI shares sequence homology and immunocrossreactivi...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000170107
更新日期:1993-01-01 00:00:00
abstract:INTRODUCTION:The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAM...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000511726
更新日期:2020-11-10 00:00:00
abstract::While the optimal vascular conduit for hemodialysis is undeniably an arterialized autogenous subcutaneous vein, only a minority of end-stage renal disease patients can count on such access: the remainder require implantation of a biomaterial conduit. This paper will briefly survey current biografts used for hemodialys...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000170148
更新日期:1994-01-01 00:00:00
abstract::Clinical trials using very low protein supply supplemented with amino acid or keto acid preparations have shown the possibility of slowing the rate of decline of renal function in patients with advanced chronic renal failure together with preservation of nutritional status. The possible mechanisms by which this effect...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,评审
doi:10.1159/000169557
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:The relationship between predialysis blood pressure (BP) and hemodialysis (HD) patient outcomes is controversial. We report the evolution of predialysis BP in incident patients treated with the dry weight method and its relationship with patients' outcomes. METHODS:Between January 2000 and 2009, 308 patient...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000337101
更新日期:2012-01-01 00:00:00
abstract::The recent interest in the role of the intestine in the cardiovascular stability of uremic patients, specifically on dialysis, but potentially also in chronic kidney disease, must be seen against the background of the recent great interest in the role of the gut in chronic heart failure [Curr Opin Clin Nutr Metab Care...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000321848
更新日期:2011-01-01 00:00:00
abstract::The effect of blood-membrane interaction on several biocompatibility parameters has been investigated. Four groups of healthy subjects underwent sham hemodialysis, i.e. the establishment of blood-dialysis membrane contact, but without circulating dialysate, using cellulose-based membranes (regenerated cellulose and ce...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000170153
更新日期:1994-01-01 00:00:00
abstract::Several strategies have been proposed to increase dialysis efficiency in order to reduce dialysis treatment time. Paired filtration dialysis (two-chamber technique) is a new technique combining the advantages of highly permeable membranes and convective transport with the high depurative efficacy of diffusion. The sys...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169955
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND/AIMS:The objective of this study is to evaluate the relation between sclerostin, arterial stiffness, and cardiovascular events (CVE) in hemodialysis patients (HD). METHODS:Sclerostin level and carotid-femoral pulse wave velocity (PWV) in 97 HD patients and sclerostin level in 40 controls were measured. RES...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000487223
更新日期:2018-01-01 00:00:00
abstract::This paper briefly reviews the physiological components of the microcirculation, focusing on its function in homeostasis and its central function in the realization of oxygen transport to tissue cells. Its pivotal role in the understanding of circulatory compromise in states of shock and renal compromise is discussed....
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000503775
更新日期:2020-01-01 00:00:00
abstract::The biological processes governing vascular endothelial cell health are complex and highly redundant. The mechanisms involved in cell injury and repair remain an area of intense study. This paper attempts to review current knowledge regarding hormones such as vitamin D, erythropoietin and aldosterone within the contex...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000089436
更新日期:2006-01-01 00:00:00
abstract::In previous reports of the Frequent Hemodialysis Network trials, frequent hemodialysis (HD) reduced extracellular fluid (ECF) and left ventricular mass (LVM), with more pronounced effects observed among patients with low urine volume (UVol). We analyzed the effect of frequent HD on interdialytic weight gain (IDWG) and...
journal_title:Blood purification
pub_type: 杂志文章,随机对照试验
doi:10.1159/000441966
更新日期:2016-01-01 00:00:00
abstract::The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000345755
更新日期:2013-01-01 00:00:00