Nephron. Physiology
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Nephron. Physiology · Jan 2014
Central venous oxygen saturation: a potential new marker for circulatory stress in haemodialysis patients?
Haemodialysis causes recurrent haemodynamic stress with subsequent ischaemic end-organ dysfunction. As dialysis prescriptions/schedules can be modified to lessen this circulatory stress, an easily applicable test to allow targeted interventions in vulnerable patients is urgently required. ⋯ This initial study demonstrates ScvO2 sampling is practical, with a potential clinical utility as an indicator of circulatory stress during dialysis.
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Nephron. Physiology · Jan 2014
The utility of the additive EuroSCORE, RIFLE and AKIN staging scores in the prediction and diagnosis of acute kidney injury after cardiac surgery.
Acute kidney injury (AKI) following cardiac surgery is a complication associated with high rates of morbidity and mortality. We compared staging systems for the diagnosis of AKI after cardiac surgery, and assessed pre-operative factors predictive of post-operative AKI. ⋯ AKI after cardiac surgery is associated with delayed discharge and high mortality rates. The AKIN and RIFLE criteria identify patients at a range of AKI severity levels suitable for trial recruitment. The utility of EuroSCORE as a risk stratification tool to identify high AKI-risk subjects for prospective intervention merits further study.
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Nephron. Physiology · Jan 2014
Is the systemic microvascular endothelial glycocalyx in peritoneal dialysis patients related to peritoneal transport?
The capillary wall coated by the endothelial glycocalyx is the main transport barrier during peritoneal dialysis (PD). Here, we investigated the relationships between measurements of the systemic endothelial glycocalyx and peritoneal transport in PD patients. ⋯ No relationships are present between the systemic endothelial glycocalyx, which was assessed by SDF, and peritoneal transport. In nonfast transporters, a reduction in blood vessel density caused by endothelial glycocalyx alterations or a thicker permeable phase of the glycocalyx delaying the access of small solutes to the small pores may be important. .
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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.