IntroductionThe risk for renal complications from hydroxyethyl starch 130/0.42 (HES) impacts treatment decisions in patients after cardiac surgery. Objective The objective of this study was to determine the impact of postoperatively administered HES on renal function and 90-day mortality compared to sole crystalloid administration in patients after elective cardiac surgery. Methods Using electronic health records from a university hospital, confounding-adjusted models analyzed the associations between postoperative HES administration and the occurrence of postoperative acute kidney injury. In addition, 90-day mortality was evaluated. The impact of HES dosage and timing on renal function on trajectories of estimated glomerular filtration rates over the postoperative period was investigated using linear mixed-effects models. Results Overall 1009 patients (45.0%) experienced acute kidney injury. Less acute kidney injury occurred in patients receiving HES compared with patients receiving only crystalloids for fluid resuscitation (43.7% vs 51.2%, p = 0.008). In multivariate acute kidney injury models, HES had a protective association (odds ratio: 0.89; 95% confidence interval 0.82-0.96). Crystalloids were not as protective as HES (odds ratio: 0.98; 95% confidence interval 0.95-1.00). There was no association between HES and 90-day mortality (odds ratio: 1.05; 95% confidence interval 0.88-1.25). Renal function trajectories were dose dependent and biphasic, HES appeared to slow down the late postoperative decline. Conclusions This study showed no association between HES and the postoperative occurrence of acute kidney injury and thus further closes the evidence gap on HES safety in cardiac surgery patients. Although this was a retrospective cohort study, the results indicated that HES might be safely administered to cardiac surgery patients with regard to renal outcomes, especially if it was administered early and dosed appropriately.
In adult patients with bronchiectasis, liver cirrhosis and pancreatic insufficiency in combination or with only one of these symptoms, cystic fibrosis should be included into the differential diagnosis.
BackgroundThe impact of rheumatoid arthritis (RA) on quality of life is impressive due to functional impairment, negative mental impact and feel of social isolation. To improve the quality of life of the patient, three critical areas have been identified: improved self-insight, enabled sharing with the rheumatologist and socializing with peers.Based on patient input an app was developed. The app served as the patient' own tool used for disease monitoring.ObjectivesTo develop an app, which can be used in daily life to measure mood, pain, fatigue and stiffness. The data will be used by the patient for daily use and it will be used in the communication with the rheumatologist.Furthermore, to develop an app which can be used for connecting with peers and asking for advice.MethodsAn app, named RheumaBuddy, has been developed based on patient-input covering the needs of young people with RA in Denmark. RheumaBuddy is an app focused on achievement of self-empowerment. Through the app patients gets a better overview of the actual status of their disease, discovering patterns and getting hints to change their daily activities in a positive direction.The app has been developed in a joint-venture with participation of the patient association, a digital health service provider and a rheumatologist/professor within RA. The design and functionality of the app is based on the theory of co-creation with patients as the primary user and source, and with several test rounds and adjustments.ResultsRheumaBuddy is developed and tested among patients and rheumatologist.Through several workshops and local meetings in Denmark, the patient association has identified the needs for an empowerment tool.The app has been tested in 4 patient sessions with 2-5 patients participating in each session. The app was evaluated as good and progressive by the patients. Patient feedback is that it supports them in taking control of their disease.The app has been presented to 3 rheumatologists, who all recognized the data points collected in the app as relevant for consultations, and they found the app relevant for daily use.In general, patients in Denmark have shown great interest in the app, and it has empowered the patient association itself.ConclusionsThere is a potential to leverage smartphone technology to empower patients themselves, enabling better communication with the healthcare professionals and to foster knowledge sharing and help with peers.RheumaBuddy has shown to be an operational tool which can be used. The app is planned for roll out to other countries in Europe, thereby extending the buddy-community and raising the quality of data available for research.The impact of usage of such an instrument has to be validated in daily practice.AcknowledgementsAbbVie Denmark for providing a grant for the development costs of the app.Disclosure of InterestJ. Rickmann: None declared, B. Schiøttz-Christensen: None declared, A. Dam Shareholder of: RheumaBuddy App
Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.
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