Incidence, risk factors, and prognosis of gastrointestinal hemorrhage complicating acute renal failure

Fiaccadori, Enrico; Maggiore, Umberto; Clima, Barbara; Melfa, Luigi; Rotelli, Carlo; Borghetti, A

doi:10.1046/j.1523-1755.2001.0590041510.x

Cited by 98 publications

(56 citation statements)

References 39 publications

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“…Although AKI is a well recognized high-bleeding risk condition (1), the patency of the extracorporeal circuit for RRT is usually maintained by the use of systemic anticoagulation with unfractionated heparin (2,3). However, a high incidence of hemorrhagic complications has been documented in patients undergoing RRT in the intensive care unit (ICU), with wide variability (5%-30%) related to differences in patient populations and anticoagulation protocols (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

Morabito

Pistolesi

Tritapepe

et al. 2014

Clinical Journal of the American Society of Nephrology

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124

130

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Hemorrhagic complications have been reported in up to 30% of critically ill patients with AKI undergoing RRT with systemic anticoagulation. Because bleeding is associated with significantly increased mortality risk, strategies aimed at reducing hemorrhagic complications while maintaining extracorporeal circulation should be implemented. Among the alternatives to systemic anticoagulation, regional citrate anticoagulation has been shown to prolong circuit life while reducing the incidence of hemorrhagic complications and lowering transfusion needs. For these reasons, the recently published Kidney Disease Improving Global Outcomes Clinical Practice Guidelines for Acute Kidney Injury have recommended regional citrate anticoagulation as the preferred anticoagulation modality for continuous RRT in critically ill patients in whom it is not contraindicated. However, the use of regional citrate anticoagulation is still limited because of concerns related to the risk of metabolic complications, the complexity of the proposed protocols, and the need for customized solutions. The introduction of simplified anticoagulation protocols based on citrate and the development of dialysis monitors with integrated infusion systems and dedicated software could lead to the wider use of regional citrate anticoagulation in upcoming years.

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Section: Introductionmentioning

confidence: 99%

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

Morabito

Pistolesi

Tritapepe

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

124

130

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“…Many potential mechanisms can be hypothesised; for example reduced epithelial microperfusion in cardiac failure, 189 decreased oxygen levels in chronic obstructive pulmonary disease, 190,191 the poor nutritional status in many diseases, or the platelet and clotting dysfunction in end stage renal failure. 109,192 However it is unlikely that there is a single mechanism that accounts for the association we found but rather that multiple illnesses and mechanisms have a cumulative effect, as shown by the graded effect of the Charlson index and by table 6 where no individual disease accounted for the magnitude of the overall association with co-morbidity.…”

Section: Chapter 8: Co-morbidity As a Risk Factor For Bleedingmentioning

confidence: 79%

“…80,103 However peptic ulcer disease was included in the measure of overall co-morbidity in the latter study and in the former study the authors used an unmatched analysis on matched data, incorrectly summed the adjusted population attributable fractions and assumed the remaining proportion were due to 'unmeasured factors'. Other studies assessed higher alcohol intake, 111 Helicobacter pylori, 81 smoking, 114 acute renal failure, 109 and acute myocardial infarction 107 and found associations with upper gastrointestinal bleeding. However these studies were in small selected hospitalised cohorts My study has a number of important strengths when compared to these previous works because I set out specifically to assess the degree to which non gastrointestinal co-morbidity predicts non variceal upper gastrointestinal bleeding after removing the effects of all the available known risk factors in a much larger general population.…”

Section: Discussionmentioning

confidence: 99%

“…However this is not necessarily the case and cannot be assessed without an appropriate comparison group. Acute renal failure also has a high incidence of upper gastrointestinal bleeding 13% 109 with a subsequent increase in mortality (adjusted OR 2.6(1.3-5.1)), and following surgical procedures at two university hospitals (n=25,845), a high gastrointestinal bleeding incidence was reported at 0.39% of patients, with an associated CHAPTER 2: BACKGROUND: Risk factors for bleeding mortality of 31%. 110 Most of this bleeding was due to erosive gastritis (70%) or ulceration (18%) and occurred in the sicker patients with sepsis and or multi organ dysfunction, as well as in those who were prescribed NSAIDS during the admission.…”

Section: Recent Trends In Short Term Case Fatality For Variceal Haemomentioning

confidence: 99%

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Epidemiology of Upper Gastrointestinal Bleeding

Crooks¹,

Sung²,

Card³

2014

GI Epidemiology

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“…Böbrek yetmezliği GI motilite üzerine negatif etkiye sahiptir ve ABH'dan bağımsız olarak YBÜ hastalarında GI sistem fonksiyonları üzerine negatif etkiye sahip çok sayıda faktör vardır: ilaçlar (sedatifler, katekolaminler, opiyatlar), hiperglisemi, elektrolit bozuklukları, mekanik ventilasyon (39). ABH, üst GI sistem kanaması için önemli bir risk faktörüdür (40), ancak bu özel klinik durumda enteral beslenmenin stres ülser/kanaması riskine karşı koruyucu olup olmadığı Fosfor: Fosfor hücre içi önemli bir elektrolit olup hücre metabolizması ve adenozintrifosfat üretiminde gereklidir. Fosfor düzeyi de PTH, vitamin D ve böbrekler tarafından düzenlenir ve ABH'lı hastalarda sıklıkla hiperfosfatemi gözlenir.…”

Section: Akut Böbrek Hasarında Beslenme Desteği Endikasyonları Ve Uygunclassified

Nutritional Support in Acute Kidney Injury

Bilgic¹,

Akçay²,

Sezer³

2013

turk Neph Dial Transpl

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ÖZAkut böbrek hasarı (ABH), hastanede yatan hastalarda oldukça sık karşılaşılan bir komplikasyondur ve morbidite ve mortalitede artış ile ilişkilidir. ABH nadiren izole organ yetmezliği olarak görülür, daha sıklıkla kritik hastalık olarak tanımlanan ciddi ve uzamış katabolik faz ile karakterize çoklu organ yetmezliği sendromunun bir parçası olarak ortaya çıkar. ABH'lı hastalar sıklıkla protein-enerji tüketimi içindedir ki bu önemli bir olumsuz prognostik faktördür. Akut böbrek hasarlı hastalarda malnütrisyon, komplikasyon gelişme riski, hospitalizasyon süresi ve hastane mortalitesinde artış ile ilişkilidir. Bu nedenle ABH'lı hastaların tedavisinde uygun beslenme desteğinin yer alması elzemdir. Beslenme gereksinimi değerlendirilirken hastanın altta yatan hastalığı, komorbid durumları ve böbrek fonksiyon bozukluğunun ciddiyeti ile renal replasman tedavisi (RRT) ihtiyacı dikkate alınmalıdır. ABH'da beslenme desteğinin esas amacı, normal böbrek fonksiyonuna sahip kritik hastalar için önerilene benzerdir: yeterli miktarda besin öğesi sağlandığından emin olmak, metabolik komplikasyonlara eşlik eden protein-enerji tüketimini önlemek ve mortaliteyi azaltmak. ABH, aynı hastanın bile klinik takip süresince büyük ölçüde değişen beslenme ihtiyacına sahip olduğu oldukça heterojen bir hasta grubunu kapsadığından beslenme gereksinimi açısından değerlendirme aralıklı olarak tekrar edilmeli, bireyselleştirilmeli ve RRT ile bütünleştirilmelidir.. AnAhtAR SÖZcüKLER: Akut böbrek hasarı, Beslenme değerlendirmesi, Beslenme tedavisi ABStRActAcute kidney injury (AKI) is a frequent complication affecting many hospitalized patients and is associated with increased morbidity and mortality. AKI seldom occurs as isolated organ failure; much more often it emerges as a component of the multiple organ failure syndrome, within the framework of the severe-prolonged catabolic phase determined by critical illness. Patients with AKI often have protein-energy wasting, which represents a major negative prognostic factor. Malnutrition in AKI patients is associated with increased risk of complications, longer hospitalization, and higher hospital mortality. Hence, appropriate nutritional support is essential in the management of the AKI patient. Assessment of nutritional requirements should take into account the patient's underlying disease, comorbid medical conditions, severity of the renal dysfunction and need for RRT. The primary goals of nutritional support in AKI are the same as those suggested for critically ill patients with normal renal function: to ensure the delivery of adequate amounts of nutrients, to prevent protein-energy wasting with the attendant metabolic complications, to reduce mortality. Since AKI comprises a highly heterogeneous group of subjects with nutrient needs widely varying even along the clinical course in the same patient, nutritional requirements should be frequently reassessed, individualized and carefully integrated with RRT..

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Incidence, risk factors, and prognosis of gastrointestinal hemorrhage complicating acute renal failure

Cited by 98 publications

References 39 publications

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

Epidemiology of Upper Gastrointestinal Bleeding

Nutritional Support in Acute Kidney Injury

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