Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Jan 2015
AKI complications in critically ill patients: association with mortality rates and RRT.
AKI is associated with short- and long-term mortality. However, the exact contribution of AKI complications to the burden of mortality and whether RRT has any beneficial effect on reducing mortality rates in critically ill AKI patients are unknown. ⋯ A majority of the excess risk of mortality associated with AKI was attenuated by its fluid volume and metabolic complications, particularly in severe AKI. In addition, this study demonstrated that RRT is associated with a better outcome in patients with AKI-related complications.
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Clin J Am Soc Nephrol · Jan 2015
Urinary elafin and kidney injury in hematopoietic cell transplant recipients.
Graft-versus-host disease (GVHD) is associated with kidney injury after hematopoietic cell transplantation (HCT). Because plasma elafin levels correlate with skin GVHD, this study examined urinary elafin as a potential marker of renal inflammation and injury. ⋯ Higher urinary elafin levels are associated with an increased risk of micro- and macroalbuminuria, AKI and CKD, and death after HCT.
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As the care of patients gets more focused and directed by predetermined standards of care, physicians must not lose sight of the primary focus of their treatment goal-maximizing the quality of life of each patient. Physicians must recognize the uniqueness of each individual's experience and make every effort to understand the domains that are of concern to each patient. In addition, physicians must make sure that this focus is not obscured by the setting of arbitrary standards and targets that lend themselves to easy assessments and reporting by simple laboratory measures or computer-generated data. Finally, physicians must focus on modifying and tailoring treatment to maximize each patient's health-related quality of life.
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Clin J Am Soc Nephrol · Jan 2015
Reductions in red blood cell 2,3-diphosphoglycerate concentration during continuous renal replacment therapy.
Hypophosphatemia is a frequent complication during continuous renal replacement therapy (CRRT), a dialytic technique used to treat AKI in critically ill patients. This study sought to confirm that phosphate depletion during CRRT may decrease red blood cell (RBC) concentration of 2,3-diphosphoglycerate (2,3-DPG), a crucial allosteric effector of hemoglobin's (Hgb's) affinity for oxygen, thereby leading to impaired oxygen delivery to peripheral tissues. ⋯ CRRT-induced phosphate depletion is associated with measurable reductions in RBC 2,3-DPG concentration and a shift in the O2:Hgb affinity curve even in the absence of overt hypophosphatemia. 2,3-DPG reductions may be associated with higher risk for in-hospital death and represent a potentially avoidable complication of CRRT.