Renal failure
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There have been many studies to estimate the incidence of acute kidney injury (AKI) in critically ill patients. However, results were variable due to the non-usage of uniform criteria and retrospective design of most studies. There are no new studies from the developing countries looking at AKI in these patients since adoption of uniform Acute Kidney Injury Network (AKIN) criteria. ⋯ Older patients, those with septic shock, and those requiring prolonged mechanical ventilation had increased risk for AKI. AKI was an independent predictor of mortality.
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Comparative Study
The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding.
Continuous renal replacement therapy (CRRT) has emerged as the preferred dialysis modality for critically ill patients with acute kidney injury. The objectives of this retrospective study were to assess the effect of nafamostat on circuit patency of CRRT and the safety regarding bleeding complications in patients at high risk of bleeding. We conducted a retrospective study of 243 CRRT patients at high risk of bleeding. ⋯ The median number of RBC units transfused per CRRT day was also not different between the two groups [0.7 (0.5-1.0) units/day vs. 0.7 (0.4-1.1) units/day; p = NS]. The use of nafamostat in patients at high risk of bleeding who require CRRT effectively lengthened the filter survival time without an increase in RBC transfusion. However, 74.5% of patients at high risk of bleeding maintained an acceptable CRRT hemofilter lifespan without circuit anticoagulation.
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Multicenter Study Comparative Study
Epidemiology of postoperative acute kidney injury in Hungarian intensive care units: an exploratory analysis.
The aim of this study was to evaluate the incidence and outcome of postoperative acute kidney injury (AKI) after major noncardiac surgery in Hungarian intensive care units (ICUs). ⋯ The results of this study confirm that there is a high incidence of AKI following major noncardiac surgery, which is associated with higher ICU and in-hospital mortality.
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Comparative Study
Combination of renal biomarkers predicts acute kidney injury in critically ill adults.
Most studies so far have focused on the performance of individual biomarkers to detect early acute kidney injury (AKI) in the adult intensive care unit (ICU) patients; however, they have not determined the predictive ability of their combinations. The aim of this study was to compare the predictive abilities of plasma neutrophil gelatinase-associated lipocalin (pNGAL), urine neutrophil gelatinase-associated lipocalin (uNGAL), plasma cystatin C (pCysC), serum creatinine (sCr), and their combinations in detecting AKI in an adult general ICU population. ⋯ The biomarker combinations had better predictive characteristics compared with those of each biomarker alone.
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Comparative Study
Major barriers against renin-angiotensin-aldosterone system blocker use in chronic kidney disease stages 3-5 in clinical practice: a safety concern?
Renin-angiotensin-aldosterone system (RAAS) blockers are underutilized in patients with chronic kidney disease (CKD). We aimed to determine barriers against the use of RAAS blockers in these patients. Patients with stage 3-5 CKD referred to Hacettepe University Hospital Nephrology Unit during a 1 year period were evaluated for RAAS blocker use. ⋯ In 37.4% of patients, reasons for not starting RAAS blockers were unclear. This study showed that hyperkalemia is the major barrier against the use of RAAS blockers in patients with CKD. There was, however, a subset of patients who did not receive RAAS blockers even without clear contraindications.