Background and Objective: Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). Materials and Methods: We retrospectively analyzed data from patients (n = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. We also compared the clinical data of the surviving and non-surviving patients and examined possible related factors for poor patient outcomes. Logistic regression was used to analyze the odds ratio for patient mortality and its related factors. Results: In 32.5% (n = 186) of the patients, the renal function improved and RRT was stopped, 51.7% (n = 296) of the patients died, and 15.9% (n = 91) of the patients remained dialysis-dependent on the day of discharge from the hospital. During the period of 5 years, the outcomes of the investigated patients did not change statistically significantly. Administration of vasopressors, aminoglycosides, sepsis, pulmonary edema, oliguria, artificial pulmonary ventilation (APV), patient age ≥ 65 y, renal cause of AKI, AKI after cardiac surgery, a combination of two or more RRT methods, dysfunction of three or more organs, systolic blood pressure (BP) ≤ 120 mmHg, diastolic BP ≤ 65 mmHg, and Sequential Organ Failure Assessment (SOFA) score on the day of the first RRT procedure ≥ 7.5 were related factors for lethal patient outcome. Conclusions: The mortality rate among patients with severe AKI requiring RRT is very high—52%. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy.
Hemodialysis patients are susceptible to life-threatening arrhythmias whose incidence is markedly higher during the long interdialytic interval due to electrolyte fluctuations. Noninvasive monitoring of electrolyte fluctuations, particularly those of potassium, would enable restoring electrolyte balance before the onset of arrhythmias. This study investigates the feasibility of continuous long-term monitoring of potassium fluctuations using a single-lead electrocardiogram. We evaluate patient-specific T-wave morphology changes in the electrocardiogram using two descriptors: (i) a model-based descriptor, , developed to account for overall morphology changes, and (ii) the currently available descriptor, , sensitive to potassium levels in single-lead electrocardiograms. Electrocardiograms of 15 hemodialysis patients with pre-existent cardiac diseases were acquired continuously over the long interdialytic interval along with blood samples at predetermined time instants. Results reveal that and respond concordantly with potassium levels, and reacts to potassium lowering medication. The overlapping index of the daily distributions of and are moderately correlated with changes in potassium levels (= − 0.56 and = − 0.57, respectively). exhibits circadian variation, peaking amidst morning and decreasing until evening. appears to be less affected by motion-induced noise, which is preferable for ambulatory monitoring. Although long-term monitoring of potassium fluctuations is feasible even in complicated hemodialysis patients, the presence of concomitant electrolyte (calcium and bicarbonate) imbalances should be accounted for since it can hamper a reliable estimation. Considering that intradialytic T-wave morphologies may differ from the ones manifested between hemodialysis sessions, future studies should also strive to collect blood samples outside of hemodialysis to improve electrolyte estimation methods.
Hemodialysis (HD) patients have a higher risk of sudden death due to cardiac arrhythmias, which commonly occur during the long interdialytic interval (LII) as a result of electrolyte fluctuations (EFs). Noninvasive monitoring of EFs would enable restoring normal serum electrolyte levels (SELs) by performing early HD before the onset of arrhythmias. In this study, we propose an ECGderived descriptor, θ µ , that is noise robust and capable of capturing EFs during HD and the LII. To investigate the variation of θ µ , ECG and blood samples of 3 patients were acquired continuously, starting at Friday's HD and ending at Monday's HD. Results show that the increase of θ µ during Friday's HD is correlated with the decrease of SELs. Moreover, θ µ tends to decrease during the LII (no blood samples were obtained) and further increases during Monday's HD. If results in larger databases are confirmed, θ µ might be suitable for noninvasive monitoring of EFs during the LII.
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