Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Jul 2013
Comparative StudyQuality of care for First Nations and non-First Nations People with diabetes.
Compared with non-First Nations, First Nations People with diabetes experience higher rates of kidney failure and death, which may be related to disparities in care. This study examined First Nations and non-First Nations People with diabetes for differences in quality indicators and their association with kidney failure and death. ⋯ Compared with non-First Nations, First Nations People with diabetes but without CKD experience disparities in assessment of quality indicators and achievement of A1C target.
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Clin J Am Soc Nephrol · Jul 2013
Disentangling the ultrafiltration rate-mortality association: the respective roles of session length and weight gain.
Rapid ultrafiltration rate is associated with increased mortality among hemodialysis patients. Ultrafiltration rates are determined by interdialytic weight gain and session length. Although both interdialytic weight gain and session length have been linked to mortality, the relationship of each to mortality, independent of the other, is not adequately defined. This study was designed to evaluate whether shorter session length independent of weight gain and larger weight gain independent of session length are associated with increased mortality. ⋯ Among patients with adequate urea clearance, shorter dialysis session length and greater interdialytic weight gain are associated with increased mortality; thus, both are viable targets for directed intervention.
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Clin J Am Soc Nephrol · Jul 2013
Observational StudyVascular and renal hemodynamic changes after renal denervation.
Renal denervation (RDN) has been shown to be effective in reducing BP in treatment-resistant hypertension. Measurement of the renal and sympathetic activity revealed a decrease in sympathetic drive to the kidney and small resistance vessels after RDN. However, the consequences on renal perfusion and renal vascular resistance (RVR), as well as central hemodynamics, are unknown. ⋯ The data indicate that RDN significantly reduced peripheral and central BP. Despite reduced systemic BP, renal perfusion and function did not change after RDN.
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Clin J Am Soc Nephrol · Jul 2013
Multicenter StudyPerformance of kidney injury molecule-1 and liver fatty acid-binding protein and combined biomarkers of AKI after cardiac surgery.
AKI is common and novel biomarkers may help provide earlier diagnosis and prognosis of AKI in the postoperative period. ⋯ Postoperative elevations of KIM-1 associate with AKI and adverse outcmes in adults but were not independent of other AKI biomarkers. A panel of multiple biomarkers provided moderate discrimination for AKI.
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Clin J Am Soc Nephrol · Jul 2013
ReviewInterventional nephrology: Catheter dysfunction--prevention and troubleshooting.
Despite recommendations by various national guidelines advocating arteriovenous fistulae as the access of choice in patients undergoing hemodialysis (HD), the use of central venous catheters (CVCs) remains widespread among both incident and prevalent HD patients. Unfortunately, long-term use of CVCs is fraught with complications, which are a major cause of morbidity and death in this patient population. Complications include a high rate of infections, as well as thrombus and sheath-related mechanical dysfunction. This review addresses prevention and management of noninfectious catheter-related dysfunction.