Nephron. Physiology
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Nephron. Physiology · Jan 2013
ReviewFluid balance in patients with acute kidney injury: emerging concepts.
Intensive care unit and surgical populations are at increased risk for acute kidney injury (AKI) and oliguria, which often lead to fluid accumulation. Volume resuscitation is a cornerstone in the treatment of hemodynamic instability in these populations. However, fluid balance evaluation and its management in the critically ill can be challenging. ⋯ Instead, approaches that aim for neutral and slightly negative fluid balance or 'dry' patients after initial fluid resuscitation are favored. This may be achieved by conservative fluid strategies, diuretics or renal replacement therapy. In this paper, we will review recent findings on the principles of fluid management in AKI, including assessment of fluid need, choice of fluid solutions, influence of fluid overload on outcomes, and some practical issues to achieve fluid balance and minimize complications in patients with AKI.
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Nephron. Physiology · Jan 2013
Beyond the randomized clinical trial: citrate for continuous renal replacement therapy in clinical practice.
Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. ⋯ In routine clinical practice, regional anticoagulation with citrate is associated with significantly better circuit patency than heparin or epoprostenol.
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Nephron. Physiology · Jan 2013
Identifying the patient at risk of acute kidney injury: a predictive scoring system for the development of acute kidney injury in acute medical patients.
Acute kidney injury (AKI) in hospitalized patients has significant implications in terms of morbidity and mortality, length of hospital stay and associated costs. To date, no interventions are proven to prevent the development of AKI but this is hampered in part by the lack of early recognition of patients at risk. We aimed to determine whether a simple system could be devised from both physiological and demographic data in order to identify individuals at increased risk from the development of inpatient AKI. ⋯ The incidence of AKI complicating inpatient admissions remains high, however with the application of the derived AKI prediction score it is hoped that early recognition will translate to improved outcomes.