Advances in chronic kidney disease
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Nephrologists and critical care physicians are commonly involved in the treatment of severely poisoned patients. Various techniques exist presently to enhance the elimination of poisons. ⋯ Extracorporeal treatments include hemodialysis, hemoperfusion, peritoneal dialysis, continuous renal replacement therapy, exchange transfusion, and plasmapheresis. This review illustrates the potential indications and limitations in the application of these modalities as well as the pharmacological characteristics of poisons amenable to enhanced elimination.
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The incidence of acute kidney injury (AKI) is generally 5-7.5% in all acute care hospitalizations and accounts for up to 20% of admissions to intensive care units (ICUs). Of all of the cases of AKI during hospitalization, approximately 30-40% are observed in operative settings. AKI is a serious morbidity that is associated with greater length of hospital stay, high risk of hospital mortality, and increased risk of incident and progressive chronic kidney disease. ⋯ With limited treatment options, prevention of AKI and amelioration of its severity remain important cornerstones of improving patient outcomes. The magnitude of the problem and the unique set of patient characteristics calls for a multidisciplinary approach for the perioperative management of renal complications. The purpose of the review presented here is to discuss the current knowledge regarding the epidemiology and risk factors, outcomes, diagnoses, and prevention and treatment of AKI during the perioperative period in cardiovascular and noncardiovascular surgical settings.
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Although the use of renal replacement therapy (RRT) to support critically ill patients with acute kidney injury (AKI) has become routine, many of the fundamental questions regarding optimal management of RRT remain. This review summarizes current evidence regarding the timing of initiation of RRT, the selection of the specific modality of RRT, and prescription of the intensity of therapy. ⋯ There does not appear to be a difference in either mortality or recovery of kidney function associated with the various modalities of RRT. Finally, providing higher doses of RRT is not associated with improved clinical outcomes.
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This review is focused on minimizing complications and avoiding harm in peritoneal dialysis (PD) patients. Issues related to planning for PD are covered first, with emphasis on PD versus hemodialysis outcomes. ⋯ Finally, recommendations for preventing PD-related infections are provided. In conclusion, with proper catheter insertion technique, good training, and attention to detail during the tenure in PD, excellent outcomes can be obtained in a well-informed motivated patient.