New Approaches in the Treatment of Acute Kidney Injury

Bambauer, Rolf

doi:10.1111/j.1744-9987.2009.00719.x

Cited by 4 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An intensive search of the literature confirmed the influence of parameters such as arterial hypotension [16], hypovolemia [17], mechanical ventilation [18], the use of drugs with potentially harmful effects on kidney function [19] and the use of synthetic colloids [20]. All of these could be efficiently assessed from our electronic patient data management system.…”

Section: Discussionmentioning

confidence: 99%

Predicting restoration of kidney function during CRRT-free intervals

Heise

Gries

Moerer

et al. 2012

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundRenal failure is common in critically ill patients and frequently requires continuous renal replacement therapy (CRRT). CRRT is discontinued at regular intervals for routine changes of the disposable equipment or for replacing clogged filter membrane assemblies. The present study was conducted to determine if the necessity to continue CRRT could be predicted during the CRRT-free period.Materials and methodsIn the period from 2003 to 2006, 605 patients were treated with CRRT in our ICU. A total of 222 patients with 448 CRRT-free intervals had complete data sets and were used for analysis. Of the total CRRT-free periods, 225 served as an evaluation group. Twenty-nine parameters with an assumed influence on kidney function were analyzed with regard to their potential to predict the restoration of kidney function during the CRRT-free interval. Using univariate analysis and logistic regression, a prospective index was developed and validated in the remaining 223 CRRT-free periods to establish its prognostic strength.ResultsOnly three parameters showed an independent influence on the restoration of kidney function during CRRT-free intervals: the number of previous CRRT cycles (medians in the two outcome groups: 1 vs. 2), the "Sequential Organ Failure Assessment"-score (means in the two outcome groups: 8.3 vs. 9.2) and urinary output after the cessation of CRRT (medians in two outcome groups: 66 ml/h vs. 10 ml/h). The prognostic index, which was calculated from these three variables, showed a satisfactory potential to predict the kidney function during the CRRT-free intervals; Receiver operating characteristic (ROC) analysis revealed an area under the curve of 0.798.ConclusionRestoration of kidney function during CRRT-free periods can be predicted with an index calculated from three variables. Prospective trials in other hospitals must clarify whether our results are generally transferable to other patient populations.

show abstract

Section: Discussionmentioning

confidence: 99%

Predicting restoration of kidney function during CRRT-free intervals

Heise

Gries

Moerer

et al. 2012

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…The renal diseases are concluded with some notes of acute kidney injury as an independent disease [110]. The variety of the causes that can trigger AKI justifies a close examination of this disease.…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

“…Thereafter, further measures against the noxae are no longer effective; all that then remains is life-long dialysis and/or kidney transplantation [112]. Given the new treatment possibilities, the customary classification of these factors in pre-renal, post-renal, and renal disorders is simplistic from a therapeutic point of view [110].…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

“…It comprises postrenal disorders, with the exception of intratubular obstruction through substances originally circulating in the blood that precipitate in the tubule lumen (urates, hemoglobin, myoglobin) as a result of urine concentration. Therapy varies according to the nature of the postrenal disorder and is usually treated by urologists [110]. With regard to the treatment of plasma disorders in particular, plasmapheresis opens up a new approach.…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

“…1. conventional plasma exchange with hollow fibers could be implemented alone or in combination with dialysis treatments, and 1-5 treatments are recommended every 1-2 days depending on the course and severity of the AKI [110]. 2. selective plasma separation, such as cascade filtration, bio-doi: 10.7243/2054-7161-1-2 logical or non-biological adsorption methods, and whole blood adsorption are available.…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic apheresis in nephrology

Bambauer¹,

Bambauer²,

Latza³

et al. 2014

Clin Nephrol Urol Sci

View full text Add to dashboard Cite

Therapeutic plasma exchange (TPE) with hollow fiber modules is used in different severe diseases since more than 35 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors try to give an overview of therapeutic apheresis (TA) in renal diseases. The updated information on immunology and molecular biology of different renal diseases are discussed in relation to the rationale for apheresis therapy and its place in combination with other modern treatments. The different renal diseases can be treated by various apheresis methods such as TPE with substitution solution, or with online plasma or blood purification using adsorption columns which contain biological or non biological agents. The following diseases are discussed: rapidly progressive glomerulonephritis (RPGN) including anti-glomerular basement membrane antibody glomerulonephritis (anit-GBM RPGN), RPGN with or without glomerular deposition (ANCA-ab), pauci-immune RPGN, immune complex nephritis (ICN), and various glomerulonephritis with nephrotic syndrome (NS), hemolytic-uremic syndrome (HUS), myoglobulinemic renal failure, acute kidney injury (AKI), and kidney transplant rejection. For the renal diseases which can be treated with TA the guidelines of the Apheresis Applications Committee (AAC) of the American Society for Apheresis (ASFA) are cited.

show abstract

Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

et al. 2018

View full text Add to dashboard Cite

BackgroundDespite aggressive application of continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury (AKI), there is no consensus on diuretic therapy when discontinuation of CRRT is attempted. The effect of diuretics on discontinuation of CRRT in critically ill patients was evaluated.MethodsThis retrospective cohort study enrolled 1176 adult patients who survived for more than 3 days after discontinuing CRRT between 2009 and 2014. Patients were categorized depending on the re-initiation of renal replacement therapy within 3 days after discontinuing CRRT or use of diuretics. Changes in urine output (UO) and renal function after discontinuing CRRT were outcomes. Predictive factors for successful discontinuation of CRRT were also analyzed.ResultsThe CRRT discontinuation group had a shorter duration of CRRT, more frequent use of diuretics after discontinuing CRRT, and greater UO on the day before CRRT discontinuation [day minus 1 (day − 1)]. The diuretics group had greater increases in UO and serum creatinine elevation after discontinuing CRRT. In the CRRT discontinuation group, continuous infusion of furosemide tended to increase UO more effectively. Multivariable regression analysis identified high day − 1 UO and use of diuretics as significant predictors of successful discontinuation of CRRT. Day − 1 UO of 125 mL/day was the cutoff value for predicting successful discontinuation of CRRT in oliguric patients treated with diuretics following CRRT.ConclusionsDay − 1 UO and aggressive diuretic therapy were associated with successful CRRT discontinuation. Diuretic therapy may be helpful when attempting CRRT discontinuation in critically ill patients with AKI, by inducing a favorable fluid balance, especially in oliguric patients.

show abstract

New Approaches in the Treatment of Acute Kidney Injury

Cited by 4 publications

References 18 publications

Predicting restoration of kidney function during CRRT-free intervals

Predicting restoration of kidney function during CRRT-free intervals

Therapeutic apheresis in nephrology

Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Contact Info

Product

Resources

About