Blood purification
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International survey on the management of acute kidney injury in critically ill patients: year 2007.
Several aspects of acute kidney injury (AKI) management, including medical approaches to AKI patients and the optimal form of renal replacement therapy (RRT), remain a matter of debate. ⋯ New classifications such as the RIFLE criteria did improve the well-known uncertainty about the definition of AKI. Awareness of the prescription and standardization of an adequate treatment dose seemed to have increased in recent years, even if there is still a significant level of uncertainty on this specific issue. Several concerns and RRT complications, such as bleeding and anticoagulation strategies, still need further exploration and development.
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We have evaluate the effect of slow continuous ultrafiltration (SCUF) on cardiac output (CO) and other hemodynamic parameters related to the overall performance of the cardiovascular system in patients with congestive heart failure (CHF). Minimally invasive hemodynamic monitoring was performed via the radial artery using a pressure recording analytical method (PRAM) during SCUF treatment. ⋯ In CHF patients, ultrafiltration improves not only CO, as previously reported, but also contractile cardiac efficiency and performance. The PRAM system, a minimally invasive method, was able to record hemodynamic changes during SCUF treatment.
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Appropriate antibacterial therapy is important to maximize patient survival in sepsis. Acute renal failure complicates optimal antibiotic administration. ⋯ Individualized dosing based on first principles may be the most appropriate method of dosing, particularly when enhanced by therapeutic drug monitoring.
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Review Comparative Study
Peritonitis - does peritoneal dialysis modality make a difference?
Peritonitis remains a significant problem for patients on peritoneal dialysis (PD). There is a certain amount of controversy as to whether peritoneal modality is itself a risk factor for peritonitis, with one modality higher than another. ⋯ At the present time, the best data suggest that use of APD with Luer lock connections versus CAPD with a disconnect system results in a reduction in peritonitis risk. More studies are needed on this important topic, particularly the possible advantage of initiating PD with a dry day in those with residual kidney function. This question would be best studied with an RCT comparing peritonitis rates in three groups of patients, i.e. those initiating dialysis on CCPD, CAPD and APD with a dry day.
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Large-scale adoption of regional citrate anticoagulation (RCA) is prevented by risks of the technique as practiced traditionally. Safe RCA protocols with automated delivery on customized dialysis systems are needed. ⋯ Using predictive Q(Ca) dosing and integrating control of the infusion pumps with the dialysis machine, SLED-RCA can be near-automated today to provide a user-friendly and safe system.