Renal failure
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Comparative Study
Mortality risk factors and validation of severity scoring systems in critically ill patients with acute renal failure.
Risk stratification and prediction of outcome in acute renal failure patients in the intensive care unit are important determinants for improvement of patient care and design of clinical trials. ⋯ Cross-validation of prognostic models for ARF resulted in poor performance of all studied scores. Therefore, a specific model is still warranted for the design of clinical trials, comparison of studies, and for prediction of outcome in ARF patients, especially in the ICU.
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Randomized Controlled Trial Comparative Study
A prospective randomized study to compare ultrasound-guided with nonultrasound-guided double lumen internal jugular catheter insertion as a temporary hemodialysis access.
Internal jugular venous catheters (IJVC) for hemodialysis are a commonly employed temporary vascular access for hemodialysis. Most hospitals still follow the use of blind technique, which uses anatomical landmarks. Even in the most experienced hands this procedure has a variable success rate. Ultrasound guidance can decrease the incidence of periprocedural complications and improve the success rate. In this randomized study we compared the procedure success rate and periprocedural complications in patients undergoing ultrasound guided vs. nonultrasound guided IJVC insertion for a temporary hemodialysis access. ⋯ Ultrasound guided procedure for internal jugular vein catheter insertion using an ordinary ultrasound machine was significantly safer and more successful as compared to the blind technique.
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Randomized Controlled Trial Clinical Trial
Effect of off-pump and on-pump coronary artery bypass grafting on renal function.
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) has the risk of renal dysfunction. The cause of renal dysfunction after CPB is multifactorial, such as nonpulsatile flow, renal hypoperfusion, hypothermia, and duration of CPB. This study compared off-pump technique with on-pump technique on renal function in patients who underwent CABG. ⋯ The off-pump technique may provide a positive contribution and sufficient protection on postoperative renal functions in patients undergoing CABG.
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Insulin resistance (IR) frequently accompanies end-stage renal disease (ESRD). There is a positive correlation between IR and cardiovascular pathologies that plays a role in mortality and morbidity on patients with ESRD. We aim to research the prevalence and evaluability of homeostasis model assessment-insulin resistance (HOMA-IR) in hemodialysis (HD) patients and also to evaluate the relationship of this value with various clinical parameters. ⋯ There was a positive correlation between low HOMA-IR value with target hct levels and administration of the rHuEpo. Because insulin resistance is an independent risk factor of cardiovascular mortality in ESRD patients, it was accepted that being able to correct the insulin resistance could be a novel therapeutic approach in this cohort.
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The purpose of this study was to obtain a detailed picture of the delivery of all aspects of pre-end stage renal disease (ESRD) care in an academic nephrology practice. The study consisted of a cross-sectional review of the charts of 111 patients with chronic kidney disease (CKD) (Creatinine >1.5 mg/dL for males, Creatinine > 1.3 mg/dL for females) followed either in a private practice or a public hospital clinic. Charts were reviewed for evidence of a number of quality of care items including the degree of blood pressure control, the use of angiotensin II blockade, treatment of anemia, bone disease, and cardiovascular risk factors, as well as evidence of dialysis orientation and vascular access placement. ⋯ However it also reveals many areas where care could be improved. This was particularly true in the areas of access placement, bone and mineral metabolism, and cardiovascular disease. It will be interesting to see whether the recent introduction of CKD guidelines by the National Kidney Foundation (NKF) and the associated educational initiatives for primary care physicians and nephrologists that are planned will further serve to improve the management of CKD patients in the years to come.