Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Nov 2016
Multicenter StudyDevelopment of a Multicenter Ward-Based AKI Prediction Model.
Identification of patients at risk for AKI on the general wards before increases in serum creatinine would enable preemptive evaluation and intervention to minimize risk and AKI severity. We developed an AKI risk prediction algorithm using electronic health record data on ward patients (Electronic Signal to Prevent AKI). ⋯ Readily available electronic health record data can be used to improve AKI risk stratification with good to excellent accuracy. Real time use of Electronic Signal to Prevent AKI would allow early interventions before changes in serum creatinine and may improve costs and outcomes.
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Clin J Am Soc Nephrol · Nov 2016
Randomized Controlled Trial Multicenter Study Comparative StudyThe Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study.
Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown. ⋯ Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis.
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Clin J Am Soc Nephrol · Sep 2016
Multicenter StudyUrinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome.
A major challenge in early treatment of acute cardiorenal syndrome (CRS) is the lack of predictors for progression of AKI. We aim to investigate the utility of urinary angiotensinogen and other renal injury biomarkers in predicting AKI progression in CRS. ⋯ uAGT, uNGAL, and uIL-18 measured at time of AKI diagnosis improved risk stratification and identified CRS patients at highest risk of adverse outcomes.
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Clin J Am Soc Nephrol · Jun 2016
Randomized Controlled Trial Multicenter StudyOral Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor Roxadustat (FG-4592) for the Treatment of Anemia in Patients with CKD.
Roxadustat (FG-4592), an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis, regulates iron metabolism, and reduces hepcidin, was evaluated in this phase 2b study for safety, efficacy, optimal dose, and dose frequency in patients with nondialysis CKD. ⋯ In patients with nondialysis CKD who were anemic, various starting dose regimens of roxadustat were well tolerated and achieved anemia correction with reduced serum hepcidin levels. After anemia correction, hemoglobin was maintained by roxadustat at various dose frequencies without intravenous iron supplementation.
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Clin J Am Soc Nephrol · Mar 2016
Multicenter StudySerum Creatinine Back-Estimation in Cardiac Surgery Patients: Misclassification of AKI Using Existing Formulae and a Data-Driven Model.
A knowledge of baseline serum creatinine (bSCr) is mandatory for diagnosing and staging AKI. With often missing values, bSCr is estimated by back-calculation using several equations designed for the estimation of GFR, assuming a "true" GFR of 75 ml/min per 1.73 m(2). Using a data set from a large cardiac surgery cohort, we tested the appropriateness of such an approach and compared estimated and measured bSCr. Moreover, we designed a novel data-driven model (estimated serum creatinine [eSCr]) for estimating bSCr. Finally, we analyzed the extent of AKI and mortality rate misclassifications. ⋯ bSCr values back-estimated using currently available eGFR formulae are inaccurate and cannot correctly classify AKI stages. Our model eSCr improves the prediction of AKI but to a still inadequate extent.