While the majority of the respondents had a positive perspective toward AKI guidelines, a large variation in their knowledge of AKI risk factors, risk assessment, and nephrotoxic drugs was found. Educational efforts are needed to raise awareness and thereby reduce this variation.

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Background: Intradialysis hypotension (IDH) is the most common complication during hemodialysis procedure. Midodrine, an oral α-1 adrenergic agonist, is commonly used to prevent IDH. However, limited data is available to demonstrate midodrine effectiveness in prevention of IDH in high-risk hemodialysis patients.Objective: To evaluate the effectiveness of using midodrine in patients receiving hemodialysis concerning the incidence of IDH. Also, we aimed to explore the appropriate dose for midodrine use to prevent IDH. Methods:A retrospective cohort of adult with end-stagerenal failure.Setting: Medical and pharmacy data used in this study was retrieved from electronic health records for adult patients with end-stage renal disease on hemodialysis. Exposure: Midodrine.Outcomes measure: IDH was defined as a decline in systolic blood pressure (SBP) by ≥ 20 mmHg or a decline in mean arterial pressure (MAP) by ≥ 10 mmHg during hemodialysis session. Recurrent IDH was defined as three or more episodes of IDH throughout a year.Analysis: A descriptive analysis of the frequency of IDH and recurrent IDH. We also, compared the risk of recurrent IDH across various doses of midodrine use. Result:From a total of 68-screened patients' charts, 45 patients were included in the final analysis. 41.8% (n = 28) of the study population had an IDH that required additional interventions to restore the SBP and MAP. IDH occurred in 68% (n = 19) of patients with hypoalbuminemia (P = 0.03). Recurrent IDH occurred in 36% (n = 16) of the patients over their hemodialysis procedure. Incidence of IDH (57%, p = 0.02) and recurrent IDH (36%, p = 0.04) were statistically significant in patients who received midodrine three time per week (57%) in comparison to those who received more than three days per week. Conclusion:This exploratory study shows that a considerable proportion of patients receiving midodrine did not develop IDH or recurrent IDH. A long-term follow-up study with larger number of patients in comparison to the control group would be useful to evaluate the magnitude of efficacy of midodrine in hemodialysis patients with high risk for IDH.

BackgroundColistin antibiotic is considered a valuable and last-resort therapeutic option for MDR gram-negative bacteria. Nephrotoxicity is the most clinically pertinent adverse effect for colistin. Vivo studies suggest that administering oxidative stress-reducing agents, such as ascorbic acid, is a promising strategy to overcome colistin-induced nephrotoxicity (CIN). However, limited clinical data explores the potential benefit of adjunctive ascorbic acid therapy for preventing CIN. Therefore, this study aims to assess the potential nephroprotective role of ascorbic acid as adjunctive therapy against CIN in critically ill patients. MethodThis was a retrospective cohort study at King Abdulaziz Medical City (KAMC) for all adult critically ill patients who have received IV Colistin. Eligible patients were classified into two groups based on the ascorbic acid use as concomitant therapy within three days of colistin initiation. The primary outcome was CIN odds after colistin initiation, while the secondary outcomes were 30-day mortality, in-hospital mortality, ICU, and hospital LOS. Propensity score (PS) matching was used (1:1 ratio) based on the patient’s age, SOFA score, and serum creatinine. ResultsA total of 451 patients were screened for eligibility; 90 patients were included after propensity score matching based on the selected criteria. The odds of developing CIN after colistin initiation were similar between patients who received ascorbic acid (AA) as adjunctive therapy compared to patients who did not (OR (95%CI): 0.83 (0.33, 2.10), p-value=0.68). In addition, the 30-day mortality, in-hospital mortality, ICU, and hospital LOS were similar between the two groups. ConclusionConcomitant use of Ascorbic acid with colistin was not associated with lower odds of colistin-induced nephrotoxicity. Further studies with a larger sample size are required to confirm these findings.