Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Oct 2010
Meta AnalysisOff-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials.
Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI). ⋯ Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions.
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Clin J Am Soc Nephrol · Oct 2010
Comparative StudyCystatin C as a marker of acute kidney injury in the emergency department.
The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI. ⋯ Serum cystatin C is an early, predictive biomarker of AKI, which outperforms serum creatinine in the heterogeneous emergency department setting. However, neither biomarker discriminated between AKI and CKD. Additional biomarkers continue to be needed for improved specificity in the diagnosis of community-acquired AKI.
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Clin J Am Soc Nephrol · Oct 2010
Multicenter Study Comparative StudyOutcome of acute kidney injury with different treatment options: long-term follow-up.
The multicenter Stuivenberg Hospital Acute Renal Failure 4 study investigated outcome in patients with acute kidney injury (AKI) stratified according to disease severity by the Stuivenberg Hospital Acute Renal Failure score. Patients in need of renal replacement therapy (RRT) received intermittent RRT or continuous RRT. This study investigated long-term mortality, renal function, comorbidity, and quality of life. ⋯ Long-term outcome of AKI consists of a high additional mortality unrelated to treatment modality offered during hospitalization, varying evolution of renal recovery, and many comorbidities, but a mental health at the same level as the general population.
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Clin J Am Soc Nephrol · Sep 2010
Impact of age and overt proteinuria on outcomes of stage 3 to 5 chronic kidney disease in a referred cohort.
Population-based studies have reported outcomes and risk factors for patients with chronic kidney disease (CKD), defined primarily by decreased estimated GFR (eGFR). They are characterized by old age, low proteinuria level, and stage 3 CKD. However, many patients referred to nephrologists are younger and have overt proteinuria and advanced CKD. This study evaluated the association between outcomes and those factors among referred CKD patients. ⋯ Stratification by age, proteinuria level, and CKD stage could predict the competing outcomes of death before RRT and ESRD among CKD patients.
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Clin J Am Soc Nephrol · Sep 2010
Serum cystatin C is an early predictive biomarker of acute kidney injury after pediatric cardiopulmonary bypass.
Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass (CPB). Serum creatinine (SCr), the current standard, is an inadequate marker for AKI since a delay occurs before SCr rises. Biomarkers that are sensitive and rapidly measurable could allow early intervention and improve patient outcomes. We investigated the value of serum cystatin C as an early biomarker for AKI after pediatric CPB. ⋯ Serum cystatin C is an early predictive biomarker for AKI and its clinical outcomes after pediatric CPB.