Timing of renal replacement therapy in AKI

Bagshaw, Sean M.; Wald, Ron

doi:10.1038/nrneph.2016.92

Cited by 17 publications

(14 citation statements)

References 10 publications

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“…[2][3][4] Current treatment for AKI is mainly supportive in nature, and there is no therapeutic modality with proven efficacy thus far. 5 In this context, early detection for AKI is paramount for eventually developing an effective intervention, as current diagnostic criteria including serum creatinine and urine output represent late manifestations of the condition. 6 Over the past decades, the nephrology community has made great efforts to discover and validate biomarkers for monitoring kidney injury in the early phase of AKI.…”

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confidence: 99%

Matrix metalloproteinase-7 protects against acute kidney injury by priming renal tubules for survival and regeneration

Zhou

Zhu

et al. 2019

Kidney International

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Matrix metalloproteinase-7 (MMP-7) is a secreted endopeptidase that degrades a broad range of substrates. Recent studies have identified MMP-7 as an early biomarker to predict severe acute kidney injury (AKI) and poor outcomes after cardiac surgery; however, the role of MMP-7 in the pathogenesis of AKI is unknown. In this study, we investigated the expression of MMP-7 and the impact of MMP-7 deficiency in several models of AKI. MMP-7 was induced in renal tubules following ischemia/ reperfusion injury or cisplatin administration, and in folic acid-induced AKI. MMP-7 knockout mice experienced higher mortality, elevated serum creatinine, and more severe histologic lesions after ischemic or toxic insults. Tubular apoptosis and interstitial inflammation were more prominent in MMP-7 knockout kidneys. These histologic changes were accompanied by increased expression of FasL and other components of the extrinsic apoptotic pathway, as well as increased expression of pro-inflammatory chemokines. In a rescue experiment, exogenous MMP-7 ameliorated kidney injury in MMP-7 knockout mice after ischemia/ reperfusion. In vitro, MMP-7 protected tubular epithelial cells against apoptosis by directly degrading FasL. In isolated tubules ex vivo, MMP-7 promoted cell proliferation by degrading E-cadherin and thereby liberating b-catenin, priming renal tubules for regeneration. Taken together, these results suggest that induction of MMP-7 is protective in AKI by degrading FasL and mobilizing b-catenin, thereby priming kidney tubules for survival and regeneration.Matrix metalloproteinase-7 (MMP-7) is an early and valuable biomarker for predicting severe AKI and poor outcomes in patients after cardiac surgery. The present study indicates that induction of endogenous MMP-7 is protective in AKI by priming kidney tubules to survival and regeneration. These results suggest that other urinary biomarkers of the early phase of AKI manifest an initial attempt of the kidney to protect against injury and to promote repair after AKI. Whether infusion of exogenous MMP-7 can protect kidneys against AKI in patients warrants further investigation. www.kidney-international.org b a s i c r e s e a r c h Kidney International (2019) 95, 1167-1180

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confidence: 99%

Matrix metalloproteinase-7 protects against acute kidney injury by priming renal tubules for survival and regeneration

Zhou

Zhu

et al. 2019

Kidney International

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“…The survey data related to RRT initiation [ 23–25 ] were also conflicting in several respects. Along with electrolyte/acid-base disturbances, multi-organ failure, and fluid overload, “acute kidney injury” was commonly reported as an important initiation criterion.…”

Section: Discussionmentioning

confidence: 99%

Renal replacement therapy practices for patients with acute kidney injury in China

et al. 2017

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Recent data indicate AKI is very common among hospitalized Chinese patients and continuous renal replacement therapy (CRRT) is increasingly offered for treatment. However, only anecdotal information regarding CRRT’s use in relation to other modalities and the specific manner in which it is prescribed exists currently. This report summarizes the results of a comprehensive physician survey designed to characterize contemporary dialytic management of AKI patients in China, especially with respect to the utilization of CRRT. The survey queried both nephrologists and critical care physicians across a wide spectrum of hospitals about factors influencing initial RRT modality selection, especially patient clinical characteristics and willingness to receive RRT, treatment location, and institutional capabilities. For patients initially treated with CRRT, data related to indication, timing of treatment initiation, dose, anticoagulation technique, and duration of therapy were also collected. Among AKI patients considered RRT candidates, the survey indicated 15.1% (95% CI, 12.3%-17.9%) did not actually receive dialysis at Chinese hospitals. The finding was largely attributed to prohibitively high therapy costs in the view of patients or their families. The survey confirmed the dichotomy in RRT delivery in China, occurring both in the nephrology department (with nephrologists responsible) and the intensive care unit (with critical care physicians responsible). For all patients who were offered and received RRT, the survey participants reported 63.9% (56.4%-71.3%) were treated initially with CRRT and 24.8% (19.2%-30.3%) with intermittent hemodialysis (HD) (P<0.001). The mean percentage of patients considered hemodynamically unstable at RRT initiation was 36.2% (31.3%-41.1%), although this figure was two-fold higher in patients treated initially with CRRT (43.1%; 35.8%-50.4%) in comparison to those initially treated with HD (22.4%; 16.4%-28.4%)(P<0.001). An overwhelming majority of intensive care patients were treated initially with CRRT (86.6%; 79.8–93.4%) while it was the initial modality in only 44.6% (33.5–55.7%) of patients treated in a nephrology department (P<0.001). Approximately 70% of respondents overall reported prescribing a CRRT dose in the range of 20–30 mL/kg/hr while approximately 20% of prescriptions fell above this range. Daily prescribed therapy duration demonstrated a marked divergence from values reported in the literature and standard clinical practice. Overall, the most common average prescribed value (50% of respondents) fell in the 10–20 hr range, with only 18% in the 20–24 hr range. Moreover, 32% of respondents reported an average prescribed value of less than 10 hrs per day. While the percentages for the 10–20 hrs range were essentially the same for nephrology and ICU programs, a daily duration of less than 10 hrs was much more common in nephrology programs (48.0%; 38.3%-57.9%) versus ICU programs (16%; 10.0%-24.6%)(P<0.001). Our analysis demonstrates both similarities and differences between RRT prac...

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“…In this context, classic indications for RRT initiation also apply, including severe acidosis, hyperkalemia, anuria, and/or fluid overload [49]. Further indications may include the following: removal of toxic substances (eg, acetaminophen, ammonia), difficult to treat hyponatremia, or difficult to treat hyperthermia [50,51].…”

Section: Acute Kidney Injurymentioning

confidence: 99%

Acute liver failure: An up-to-date approach

Cardoso

Marcelino

Bagulho

et al. 2017

Journal of Critical Care

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a b s t r a c t a r t i c l e i n f oAcute liver failure is a rare but potentially devastating disease. Throughout the last few decades, acute liver failure outcomes have been improving in the context of the optimized overall management. This positive trend has been associated with the earlier recognition of this condition, the improvement of the intensive care unit management, and the developments in emergent liver transplantation. Accordingly, we aimed to review the current diagnostic and therapeutic approach to this syndrome, especially in the intensive care unit setting.

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Timing of renal replacement therapy in AKI

Cited by 17 publications

References 10 publications

Matrix metalloproteinase-7 protects against acute kidney injury by priming renal tubules for survival and regeneration

Matrix metalloproteinase-7 protects against acute kidney injury by priming renal tubules for survival and regeneration

Renal replacement therapy practices for patients with acute kidney injury in China

Acute liver failure: An up-to-date approach

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