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AcuteKidneyInjury

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Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations ≥150 μmol/L (male) or ≥130μmol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P = 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.  
jasn.asnjournals.org
over 6 years ago
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Critical Care

Saline-based and hydroxyethyl starch solutions are associated with increased risk of renal dysfunction. In the present study, we tested the hypothesis that balanced solutions and a limited volume of hydroxyethyl starch solution (renal protective fluid management [RPF] strategy) would decrease the incidence of postoperative acute kidney injury (AKI) and improve clinical outcomes in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).  
ccforum.com
about 6 years ago
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0
14

Fluid Management: Buffered Crystalloid No Benefit vs Saline

Among patients in the ICU receiving crystalloid fluid therapy, use of a buffered crystalloid compared with saline did not reduce the risk for acute kidney injury in a randomized trial.  
medscape.com
about 6 years ago
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10

Managing AKI Just Got More Stressful

Do the risks of the furosemide stress test outweigh the value for patients with acute kidney injury?  
medscape.com
about 6 years ago
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5

Acute Kidney Injury Linked to BRAF Inhibitors in Melanoma

Treatment with vemurafenib and dabrafenib was associated with acute renal toxicity in patients with melanoma, according to data from the FDA Adverse Event Reporting System.  
medscape.com
about 6 years ago