Fluid overload is a frequent finding in critically ill patients suffering from acute kidney injury (AKI). To assess the impact of fluid overload on the mortality of AKI patients treated with continuous renal replacement therapy (CRRT), we used a registry of eighty-one critically ill patients with AKI initiated on CRRT assembled over an 18 month period to conduct a cross-sectional analysis using volumerelated weight gain (VRWG) of ≥10 and ≥20% of body weight, and oliguria (20 ≤mL/hour) as the principal variables, with the primary outcome measure being mortality at 30 days. Mean Apache II scores were 27.5±6.9 with overall cohort mortality of 50.6%. Mean (±SD) VRWG was 8.3±9.6 kg, representing a 10.2±13.5% increase since admission. Oliguria was present in 65.4% of patients. OR for mortality on univariate analysis was increased to 2.62 (95% CI: 1.07-6.44) by a VRWG ≥10% and to 3.22 (95% CI: 1.23-8.45) by oliguria. VRWG ≥20% had OR of 3.98 (95% CI: 1.01-15.75; p=0.049) for mortality. Both VRWG ≥10% (OR 2.71, p=0.040) and oliguria (OR 3.04, p=0.032) maintained their statistically significant association with mortality in multivariate models that included sepsis and Apache II score. In conclusion, fluid overload is an important prognostic factor for survival in critically ill AKI patients treated with CRRT. Further studies are needed to elicit mechanisms and develop appropriate interventions.
Correct estimation of the dialysis patients' hydration status remains an important clinical challenge. Bioimpedance measurements have been validated by various physiological tests, and the use of brain-type natriuretic peptide (BNP) has been validated by inferior vena cava diameter measurements. This is an observational cohort study that evaluated the correspondence between bioimpedance-measured overhydration percentage (OH%) and BNP. We measured predialysis OH% by bioimpedance apparatus (Body Composition Monitor) and BNP by microparticle enzyme-linked immunoassay in 41 prevalent stable hemodialysis patients, 19 (46%) women, aged 58.9 ± 14.5 years. The cohort's average BNP was 2694 ± 3278 pg/mL and 10 (24.4%) of these 41 patients had BNP < 500 pg/mL (average 260.7 ± 108.5). The OH% was 8.5 ± 7.0% among those with a BNP < 500 pg/mL, while the rest of the population had an OH% of 21.4 ± 8.0%, corresponding to excess volumes of 1.6 ± 1.3 and 4.4 ± 3.8 L, respectively. The OH% vs. BNP relationship was best described by the exponential regression of y = 216.4e(0.097x) , predicting a BNP of 216.4 pg/mL at 0% overhydration status (r 0.61). Receiver-operating curves revealed an area under the curve of 0.885 for BNP when the OH% was set ≥15% of overhydration and an area under the curve of 0.918 for OH% when the BNP was set ≥500 pg/mL for being abnormal. We conclude that in our cohort there was a high degree of correspondence between these two tests with an exponential relationship between the measurements.
Bedside removal of tunneled hemodialysis catheters (TDC) by noninterventional Nephrologists has not been frequently performed or studied. We performed a retrospective review of bedside TDC removal at the University of Mississippi Medical Center between January, 2010 and June, 2013. We collected data on multiple patients and procedure-related variables, success, and complications rates. Of the 138 subjects, mean age was 50 (±15.9) years, 49.3% were female, 88.2% African American and 41% diabetics. Site of removal was the right internal jugular (IJ) in 76.8%, the left IJ in 15.2%, and the femoral vein in 8% of patients. Exactly 44.9% of removals took place in the outpatient setting. Main indications for the removal were proven bacteremia in 30.4%, sepsis or clinical concerns for infection in 15.2% of the cases, while TDC was no longer necessary in 52.2% of patients. All removals were technically successful and well tolerated, but we observed Dacron "cuff" separation and subcutaneous retention in 6.5% of the cases. There was a significant association between outpatient removal and cuff retention (p = 0.007), but not with the site of removal or operator experience. In this relatively large mixed cohort of inpatients and outpatients, bedside TDC removal was well tolerated with a minimal complication rate.
Overhydration (OH) is both a major etiology of hypertension in hemodialysis patients and a serious risk factor for mortality. We investigated the association of multiple variables and OH. This is a cross-sectional study of prevalent hemodialysis patients examining the predialysis hydrational status with a portable bioimpedance apparatus to measure the degree of hydration. We completed our study in 79 patients. Patients were overhydrated by 2.6 ± 2.4 L. The mean medication count was 2.4 ± 1.5, and 50.7% had diuretics. We found a significant correlation between OH and systolic blood pressure (r = 0.39; p = 0.0006), each liter of OH generating 3.6 mm Hg. We also found a positive correlation between the use of diuretics and OH (p = 0.003, two-tailed Student's t test) but no correlation between OH and body weight (r < 0.0001; p = 0.99), body mass index (r = -0.17), age (r = 0.089), and vintage (r = 0.05). For every 10% increase in body fat, OH decreased by 1.2 L; residual urine output gave no protection from OH (r = 0.077) and did not correlate with blood pressure (r = 0.01). Overhydration is strongly associated with the use of antihypertensive medications and the use of diuretics in this dialysis population. Obesity seems to afford some protection from OH.
J Clin Hypertens (Greenwich). Liddle syndrome (LS) is an autosomal dominant disorder due to a gain‐of‐function mutation in the epithelial Na+ channel and is perceived to be a rare condition. A cross‐sectional study of 149 hypertensive patients with hypokalemia (<4 mmol/dL) or elevated serum bicarbonate (>25 mmol/dL) was conducted at a Veterans’ Administration Medical Center Hypertension Clinic in Shreveport, LA. Data on demographics, blood pressure, and select blood tests were collected and expressed as percentages for categoric variables and as mean ± standard deviation (SD) for continuous variables. Patients were diagnosed with likely LS when the plasma renin activity (PRA) was <0.35 μU/mL/h and the aldosterone was <15 ng/dL and likely primary hyperaldosteronism (PHA) with PRA <0.35 μU/mL/h and aldosterone level >15 ng/dL. The cohort included predominantly elderly (67.1±13.4 years), male (96%), and Caucasian (57%) patients. The average blood pressure was 143.8/79.8 mm Hg±27.11/15.20 with 3.03±1.63 antihypertensive drugs. Based on the above criteria, 9 patients (6%) satisfied the criteria for likely LS and 10 patients (6.7%) were diagnosed with likely PHA. In this hypothesis‐generating study, the authors detected an unusually high prevalence of biochemical abnormalities compatible with likely LS syndrome from Northwestern Louisiana, approaching that of likely PHA. J Clin Hypertens (Greenwich). 2010;12:856–860.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.