Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Rosa, Silvia De; Samoni, Sara; Villa, Gianluca; Ronco, Claudio

doi:10.1159/000452650

Cited by 3,608 publications

(24 citation statements)

References 258 publications

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“…high-risk patients can account for a large proportion of healthcare resources [17]. Critical illness is associated with greater length of stay, in-hospital mortality, and risk of dialysis dependence in observational studies among patients with CKD [3,4,18]. Our findings add to a growing field of data on CKD-related hospitalization and extend this to those in low socioeconomic settings for whom limited information is available.…”

Section: Discussionmentioning

confidence: 54%

Hospitalization and Critical Illness in Chronic Kidney Disease

Triozzi¹,

Niu²,

Walther³

et al. 2020

Cardiorenal Med

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Background: Patients with chronic kidney disease (CKD) who are hospitalized with a critical illness are at increased risk for adverse outcomes. We studied the predictors of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 in a safety-net healthcare setting. Methods: A retrospective cohort study was conducted among patients ≥18 years of age with CKD stages 3 and 4 using a CKD registry from a safety-net healthcare system. Hospitalizations with critical illness were identified among patients requiring nonelective admission or transfer to the intermediate or intensive care unit during a 3-year period after the diagnosis of CKD. Poisson regression was used to determine associations between baseline characteristics and hospitalization requiring intermediate or intensive care among all CKD patients and in those with different stages of CKD. Outcomes of these hospitalizations were also tabulated. Results: Among 8,302 patients with CKD stages 3 and 4, 1,298 were hospitalized and 495 required intermediate or intensive care during a 3-year follow-up period. In the adjusted analysis, advanced CKD, Hispanics (incident rate ratio [IRR]: 1.88), non-Hispanic Blacks (IRR: 1.48), presence of congestive heart failure (IRR: 2.09), cardiovascular disease (IRR: 1.57), chronic pulmonary disease (IRR: 1.60), liver disease, malignancy, and anemia were associated with higher risk of hospitalization requiring intermediate or intensive care. The association of age, gender, race/ethnicity, congestive heart failure, anemia, and body mass index with hospitalization requiring intermediate or intensive care differed significantly by CKD stage (p value for interaction term < 0.05). Congestive heart failure and severity of

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Section: Discussionmentioning

confidence: 54%

Hospitalization and Critical Illness in Chronic Kidney Disease

Triozzi¹,

Niu²,

Walther³

et al. 2020

Cardiorenal Med

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“…Close monitoring and management of fluid, hemodynamics, metabolic derangement, anemia, nutrition, etc is important. 69 Drugs selection to prevent nephrotoxic drugs; monitoring of kidney function by estimating serial serum creatinine and creatinine clearance is required and drug dose should be adjusted accordingly. 69 If the patient develops AKI on stable CKD, or if the patient was on maintenance HD, the patient will require postoperative HD.…”

Section: Management Overviewmentioning

confidence: 99%

Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects

Karim

Panda

Singha

2020

APIC

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Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects. Abbreviations used: AKI – Acute kidney injury; CKD - Chronic kidney disease; ESRD - End stage renal disease; eGFR: estimated Glomerular Filtration Rate; HD – Hemodilaysis; GFR - Glomerular filtration rate; KDIGO - The Kidney Disease: Improving Global Outcomes, RCRI - Revised Cardiac Risk Index; RRT- Renal Replacement Therapy Received: 28 Oct 2018Reviewed: 30 Oct 2018Corrected: 7 Nov 2018Accepted: 7 Nov 2018 Citation: Karim HMR, Panda CK, Singha SK. Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S29-S38

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“…22,23 Selain didukung oleh data pola penyakit dan komorbiditas, data skor APACHE II pada populasi pasien dalam penelitian ini menunjukkan bahwa lebih dari 50% pasien memiliki prognosis yang kurang baik dengan perkiraan kematian berkisar 73-88%. 24 Risiko infeksi nosokomial meningkat seiring dengan pola penyebaran komorbiditas PGK dan diabetes melitus (DM), terutama karena sebagian besar pasien menggunakan ventilasi mekanik dalam jangka waktu panjang. Oleh karena itu, angka insiden infeksi saluran pernafasan bawah menjadi yang paling banyak dengan proporsi 62,5% baik VAP, maupun HAP yang kemudian berkembang menjadi VAP akibat pemakaian ventilator.…”

Section: Pembahasanunclassified

Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

Setiawan

Widyati²,

Harijono

2018

Indones J Clin Pharm

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Program Pengendalian Resistensi Antibiotik (PPRA) merupakan program wajib rumah sakit Indonesia sesuai Permenkes No. 8 tahun 2015. Rumkital dr. Ramelan Surabaya termasuk salah satu rumah sakit yang telah menerapkan PPRA. Tujuan penelitian ini adalah untuk mengetahui deskripsi kuantitatif-kualitatif pemakaian antibiotik, serta luaran klinis dan mikrobiologis yang teramati pascapencanangan penerapan PPRA di ICU Rumkital dr. Ramelan Surabaya. Desain penelitian adalah studi observasi cross-sectional yang dilakukan selama 3 bulan (Februari-Mei 2016) di ICU Rumkital dr. Ramelan. Deskripsi kuantitatif diamati menggunakan Days of Therapy (DOT/100 hari-pasien), deskripsi kualitatif menggunakan alur Gyssens. Pengamatan luaran klinis dilakukan terhadap infeksi nosokomial, mortalitas terkait infeksi, dan lama tinggal di ICU (Length of Stay/LOS). Pengamatan luaran mikrobiologis dilakukan terhadap pola penyebaran bakteri multiresisten. Hasil perhitungan jumlah konsumsi antibiotik didapatkan 151,63 DOT/100 hari-pasien. Penilaian kualitas antibiotik menunjukkan hasil 52,73% terapi tepat; 8,18% tidak tepat; 7,27% tanpa indikasi; 31,82% tidak tercapai kesepakatan antar penilai (κ=0,59; p<0,05). Infeksi nosokomial terbanyak yaitu Hospital Acquired Pneumonia (HAP)/Ventilator Associated Pneumonia (VAP), mortalitas terkait infeksi 44,68%; dan LOS rata-rata 7,17±1,9 hari (p<0,05). Belum ditemukan adanya insiden Methicillin-resistant Staphylococcus aureus (MRSA) ataupun Extended Spectrum Beta-Lactamase (ESBL), namun ditemukan dua kasus Multi Drug Resistant (MDR) Acinetobacter baumannii.

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Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Cited by 3,608 publications

References 258 publications

Hospitalization and Critical Illness in Chronic Kidney Disease

Hospitalization and Critical Illness in Chronic Kidney Disease

Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects

Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

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