Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)

Background. A patent vascular access is crucial for hemodialysis patients. Stenosis and thrombosis lead to access failure. Endothelial injury via angiotensin II may mediate a hyperplastic and prothrombotic response. Thus angiotensin II inhibition with angiotensin-converting enzyme inhibitors (ACEI) may prolong vascular access patency. This study determines the impact of ACEI use on access patency in both polytetrafluroethylene (PTFE) grafts and fistulas. Methods. Demographics, access history and medication use were reviewed in 266 accesses from four dialysis centres. Primary patency, date of surgery to date of first access failure, was determined. Excluded accesses had incomplete history or <30 day patency. Groups divided into ACEI and non-ACEI based on patient use of ACEI during access patency. Statistical methods included: unpaired Student t to compare continuous variables, Chi-square and Fisher's Exact test to compare proportions and evaluate for risk estimation, univariate and multivariate Cox regression to investigate variables associated with duration of access patency. Cox-adjusted survival and Hazard curves were obtained for significant variables. Results. Non-ACEI (PTFE) graft group included more males and older patients; however, when these covariates were adjusted during both univariate and multivariate regression, suggested, only ACEI use was associated with greater access patency duration, 671.7 days (ACEI) vs 460.0 days (non-ACEI), p ¼ 0.012. ACEI group had fewer clotting events, 55% versus 71% (non-ACEI) group, p ¼ 0.042. ACEI use had little effect on primary patency of the fistula however male gender increased time to fistula failure, p ¼ 0.002. Conclusions. Retrospective evaluation suggests ACEI use in patients with PTFE grafts may prolong and maintain patency. Fistula patency is affected by gender with longer patency noted in males. Further prospective studies are necessary to confirm the role of ACEI in maintaining vascular access patency.

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The progressive loss of kidney function is accompanied by metabolic acidosis. The relationship between metabolic acidosis, nutritional status, and oral bicarbonate supplementation has not been assessed in the Indian chronic kidney disease (CKD) population who are on maintenance hemodialysis (MHD). This is a single-center prospective study conducted in the Western part of India. Thirty-five patients, who were receiving MHD were assessed for metabolic acidosis along with various nutritional parameters at the baseline and at the follow-up after 3 months, postcorrection of acidosis with oral sodium bicarbonate supplements. The relationship between the correction of metabolic acidosis with oral bicarbonate supplements and changes in dietary and various nutritional parameters were evaluated. Metabolic acidosis at the baseline evaluation was found in 62.86% cases of the cohort with a mean serum bicarbonate value of 20.18 ± 4.93 mmol/L. The correction of acidosis with increment in the mean dosage of oral sodium bicarbonate supplements from 0.69 ± 0.410 mmol/kg/day at baseline to 1.04 ± 0.612 mmol/kg/day, significantly reduced the prevalence of metabolic acidosis to 23.33% cases at the follow-up. Improvement in serum bicarbonate level showed significant dietary, anthropometric, and nutritional improvements in these patients. Hence, we conclude that correction of metabolic acidosis with optimal oral bicarbonate supplementation plays a pivotal role in the treatment of malnourished CKD patients on MHD.

Introduction: Contrast-induced nephropathy (CIN) / Contrast inducedacute kidney injury (CI-AKI) is one of the most common causes of hospital-acquired AKI. Methods: This is a prospective, single center study of 774 consecutive patients (449 males and 325 females with mean age of 48.85 AE 14.05 years) who underwent iodinated contrast procedures with nonionic, low-osmolality iodinated contrast medium (Iomeprol) via IV and IA routes from 2013 to 2015 were included in the study. CIN was defined as a relative increase of $25% or an absolute increase of >0.5 mg/dL in serum creatinine levels within 2 days post-procedure. We recorded the baseline characteristics, laboratory parameters along with underlying renal injury risk factors; contrast administration volume, type, and route of administration; incidence of CIN and requirement of dialysis and use of prophylactic measures for CIN. Univariate and multivariate models were used to determine predictors of CIN. Results: The total incidence of CIN was 14.85% (115 patients) with the incidence being 77.4% following IA contrast administration versus 22.6% following IV contrast administration (p ¼ 0.001). Baseline eGFR was lower for patients undergoing IA contrast procedures (66.02 AE 23.70 ml/min/1.73m 2 vs 71.31AE24.07 ml/min/1.73m 2 , p¼0.002). The total risk of renal replacement therapy was 1.7% (13 patients) with the incidence being more in the IA group than the IV group (3.1% vs

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