Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

Palevsky, Paul M.; Zhang, Jane Hongyuan; O’Connor, Theresa; Chertow, Glenn M.; Crowley, Susan T.; Choudhury, Devasmita; Finkel, Kevin W.; Kellum, John A.; Paganini, Emil P.; Schein, Roland M. H.; Smith, Mark W.; Swanson, Kathleen M.; Thompson, B. Taylor; Vijayan, Anitha; Watnick, Suzanne; Star, Robert A.; Peduzzi, Peter; Young, Eric W.; Fissel, R.; Fissel, W.; Patel, Utkarsh Rajesh; Belanger, Karen; Raine, A. E. G.; Ricci, Natália Aquaroni; Lohr, James W.; Arora, Puneet; Cloen, D.; Wassel, D.; Yohe, L.; Amanzadeh, Jamshid; Penfield, Jeffrey G.; Hussain, Musarrat; Katneni, Ratnaja; Sajgure, Atul; Swann, Allyson; Dolson, George M.; Ramanathan, Venkat; Tasby, G.; Bacallao, Robert L.; Jaradat, Maha; Graves, Karen; Li, Q.; Krause, Michelle W.; Shaver, May Jo; Alam, Muhammad; Morris, Kevin; Bland, T.; Satter, Ellen; Kraut, Jeffrey A.; Felsenfeld, A.; Levine, Brian J.; Nagami, Glenn T.; Vaghaiwalla, B.; Duffney, J.; Moore, J.; Cely, Cynthia; Jaimes, Edgar A.; Kett, Daniel; Quartin, Andrew A.; Arcia, M.; Barchi-Chung, Allison; Batuman, Vecihi; Alper, Ahmet Taha; Dreisbach, Albert W.; Simon, Eric E.; Kulivan, C.; Aslam, Nabeel; Mohan, Ramkumar; Grum, E.; Rogers, Paul A.; Weisbord, Steven D.; Geffel, C.; Wahba, Ihab; Kelly, Deborah; Walczyk, Jacqueline; Feldman, George M.; Mogyorósi, András; Viol, G. W.; Halverson, Matthew; Schmid, Stefan; Totten, H.P.; Gabbai, Francis B.; Mullaney, Scott; Smith, Roger; Dingsdale, J.; Woods, Steven D.; Johansen, Kirsten L.; Lovett, David H.; O’Hare, Ann M.; McCarthy, James T.; Rosado‐Rodriguez, Carlos; Galera, Ana; Rodríguez–Vega, Gloria M.; Rodriguez, William; Vilchez, Carmen Mongrut; Young, Belinda; Andress, Dennis L.; Lindner, Anett; Galvin, Grace; Gourley, N.; Peixoto, Aldo J.; Perkal, Melissa F.; Joncas, C.; Demirjian, Sevag; Yared, Jean-Pierre; Brienza, Rebecca; Garcia, Michelle; Seifert, Tracy H.; Sweeney, Lena; Rabb, Hamid; Atta, Mohammed; Brower, Roy G.; Choi, Michael; Eustace, Joseph A.; Scheel, Paul J.; Heck, Ellen; Rahman, Habibur; Niles, John L.; Bazari, Hasan; Smirnakis, Karen; Steele, David; Thadhani, Ravi; Laliberte, Karen; Leeman, B.; McCarthy, Claire; Pescatore, M.; Szerlip, Harold M.; Fall, Pamela J.; Jagadeesan, M; Mulloy, Laura L.; Paulson, William D.; White, Jonathan; Sickafoose, N.; Cho, K.; Gropper, Michael A.; Liu, K.; Matthay, Michael A.; Borovitz, K.; Koenigsberg, Mordecai; Rodríguez, Silvia Fariñas; Contreras, Gabriel; Cohn, Silvia E.; Diego, Julia; Carvalho, Clayton Barbieri de; Carvalho, Dulce; Castro, Marina Lopes; Cuesta, C.; Espinal, I.; Hurtado, Abdías; Oyuela, Pedro; Unruh, Mark; Burr, Renee; Donahoe, Michael P.; Marszalek, Joan; Shields, Martion; Venkataraman, Ramesh; Aubrecht, Jill; Sterling, Hyacinth; Mandich, LeeAnne; Shaw, Alexander R.; Foringer, John R.; Samuels, Joshua; Efron, Bradley; Rocco, Michael V.; Deterding, E.; Moossavi, Shahriar; Bethea, Cassandra; McBride, Dannielle; Warren, Simone; Kollef, Marin H.; Sambandam, Kamalanathan K.; Hammer, Elizabeth J.; Hoffman, Marc L.; Stokes, John B.; Connors, Alfred F.; Feldman, Harold I.; Greer, Joel W.; Koch, Gary G.; Stewart, Thomas G.; Wittes, Janet; Overberger, Pamela; Michler, S.; Antonelli, Massimo; Dellert, K.; Durant, LR; Franchini, Roberto; Kossack, Andrew; McBride, Virginia; O’Neil, Shawn P.; Roy, Tuhin K.; Russo, Janita C.; Vitale, Joseph J.; Sather, Mike R.; Fye, Carol L.; Haakenson, Clair; Krueger, Dagmar; Thornton, Julie; Dalzell, Connie; Horney, Rebecca A.; Siroka, Andrew; Su, Pei Yu; Brophy, Mary; Humphries, Donald E.; Govan, Duncan E.; O'Leary, Timothy J.; Huang, Guangsu; Feussner, J. R.; Eggers, Paul W.

doi:10.1056/nejmoa0802639

Cited by 1,458 publications

(477 citation statements)

References 27 publications

(6 reference statements)

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“…We anticipated an increase in gain from pulse BP to strain (∣H 2 (f)∣), based on the positive correlation between increased distension of the CCA (reduced stiffness) and BRS gain values [45,46,47]. However, our results show a decrease in vascular and overall BRS gain, simultaneously with an increase in distension, which is contrary to other findings.…”

Section: Discussioncontrasting

confidence: 83%

“…For this application, the pulse repetition frequency was 580 Hz, while peripheral BP and ECG are used as reference signals. Using the R-top of the ECG as a synchronization point, dedicated signal processing [30] provides a continuous output of end-diastolic diameter and the variation in diameter over a cardiac cycle (distension waveform) based on the evaluation of half-overlapping signal segments with a duration of 21 ms. Even though the ultrasound system interlaces B- and M-mode, the configuration allows selective capturing of ultrasound signals generated in M-mode only.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Contribution of Vascular and Neural Segments to Baroreflex Sensitivity in Response to Postural Stress

Saeed¹,

Reneman²,

Hoeks³

2009

J Vasc Res

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Background/Aims: The baroreflex pathway has a vascular and a neural segment, both being modulated by variations in peripheral blood pressure (BP). Besides overall baroreceptor sensitivity (BRS), defined as the spectral relationship between changes in peripheral BP and R-R interval within the frequency band of 0.05–0.15 Hz, vascular and neural segment contributions to the overall BRS can be distinguished. We test the hypothesis that changes in overall BRS following a postural maneuver mainly originate from the vascular (peripheral pressure to carotid artery diameter) rather than the neural segment (carotid artery diameter to R-R interval). Methods: Peripheral pressure (Finapress), carotid artery diameter (ultrasound in B-/M-mode) and electrocardiogram values of 20 young subjects in supine and upright-seated postures were recorded simultaneously. Transfer gains were computed for the segmental and overall responses. Results:Postural change significantly increases peripheral BP and carotid artery diameter. The vascular segment has a uniform spectral distribution. Statistical analyses revealed that postural change decreased overall (p < 0.004) and vascular (p < 0.0001) transfer gains, but did not modify neural gain. Conclusions:Unlike the neural segment, the vascular segment is frequency non-specific. The decrease in overall BRS due to a postural change is mainly explained by the reduced transfer gain of the vascular segment.

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Section: Discussioncontrasting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Contribution of Vascular and Neural Segments to Baroreflex Sensitivity in Response to Postural Stress

Saeed¹,

Reneman²,

Hoeks³

2009

J Vasc Res

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“…The Acute Renal Failure Trial Network (ARFTN) study demonstrated that there is no benefit of intermittent haemodialysis six times a week vs three times a week or CVVHDF at a dose of 35 ml/kg/h vs 20 ml/kg/h [26]. Similarly The Randomized Evaluation of Normal versus Augmented Level (RENAL) replacement therapy study failed to show any advantage of 40 ml/kg/h CVVHDF vs 20 ml/kg/h [27].…”

Section: Dose Of Rrtmentioning

confidence: 99%

Acute kidney injury in sepsis

Wijayaratne

Wijewickrama

2017

Sri Lanka j Surg

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Sepsis is life-threatening organ dysfunction resulting from a dysregulated host response to infection. It is one of the commonest causes of acute kidney injury (AKI) and is associated with an increase in both morbidity and mortality. Both haemodynamic and non-haemodynamic factors are involved in the pathogenesis of AKI in sepsis. Newer tests are available for the early diagnosis of AKI in septic patients and may provide an opportunity for prevention. The current mainstay of prevention is adequate fluid resuscitation and maintenance of systemic blood pressure, noradrenaline being the vasopressor of choice. Renal replacement therapy may improve outcomes. Continuous renal replacement modalities are preferred in those who are haemodynamically unstable. There is no consensus on the optimal timing or dose of renal replacement therapy.

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“…One was an American study, published in 2008, which included 1124 patients and compared doses of 20 and 35 mL kg -1 h -1 , finding no difference in mortality [14]. The other was an Australian study, published in 2009, which included 1508 patients and compared doses of 25 and 40 mL kg -1 h -1 , again finding no difference in mortality [15].…”

Section: Skepticism Regarding Higher Crrt Dosesmentioning

confidence: 99%

“…The VA/NIH Acute Renal Failure Trial Network study [4] found higher incidences of hypotension, requiring vasopressor support and electrolyte disturbances such as hypophosphatemia and hypokalemia, and a longer duration of both RRT and hospital stay in the high-intensity group compared with the less-intensive group. The Renal Replacement Therapy study [15] documented seven serious adverse events (three cases of disequilibrium syndrome despite the early initiation of RRT; [6,14,15] one case of cerebral edema; one case of rectal bleeding; one case of cardiac arrest; and one case of too rapid correction of hyponatremia). In the lower-intensity group, there were five serious adverse events (three cases of heparin-induced thrombocytopenia; one case of hypoxemia; and one of cardiogenic shock).…”

Section: Adverse Effects Of High Intensity Crrtmentioning

confidence: 99%

Validity of low-efficacy continuous renal replacement therapy in critically ill patients

Kawarazaki¹,

Uchino

2016

Anaesthesiol Intensive Ther

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The 1980s saw the use of continuous arteriovenous hemofiltration whose intensity hemofiltration rate was only 3 or 4 mL kg -1 h -1 . With the installation of a blood pump, this dose went up to 8 or 10 mL kg -1 h -1 , and continued to increase, reaching about 20 mL kg -1 h -1 by the year 2000. Some studies found that a higher dose could be beneficial, and the world rapidly followed the trend, increasing the dose up to 35 mL kg -1 h -1 . Then, two randomized control trials, namely the VA/NIH Acute Renal Failure Trial Network study and the RENAL study, came along in succession which changed the Kidney Disease: Improving Global Outcomes (KDIGO) recommendation to 20 to 25 mL kg -1 h -1 . However, no good evidence exists to support this. Our recent multicenter retrospective studies from the JSEPTIC CRRT database show that the Japanese continuous renal replacement therapy dose of (14.3 mL kg -1 h -1 ) does not seem to have worse outcomes when compared with a higher dose.

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Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

Cited by 1,458 publications

References 27 publications

Contribution of Vascular and Neural Segments to Baroreflex Sensitivity in Response to Postural Stress

Contribution of Vascular and Neural Segments to Baroreflex Sensitivity in Response to Postural Stress

Acute kidney injury in sepsis

Validity of low-efficacy continuous renal replacement therapy in critically ill patients

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