Preventing Acute Kidney Injury

Macedo, Etienne; Mehta, Ravindra L.

doi:10.1016/j.ccc.2015.06.011

Cited by 15 publications

(18 citation statements)

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“…Early diagnosis from serum creatinine and urine creatinine. (26) After diagnosis the priority is volemia maintenance and correction of volume depletion, however it is need to provide attention for not causing positive hydric balance because it is associated with high mortality. To monitor urine output there is a need of rigorous hydric balance, hemodynamic monitor and oxygenation.…”

Section: Discussionmentioning

confidence: 99%

“…To be attentive to nephrotoxic drugs and correct the dose for patients with altered renal function. (26) Indication for renal replacement therapy includes factors such as hypervolemia, electrolytic and acid-base change. Modalities depend on socioeconomic conditions of the institution, country, and health system, in addition to specific reasons as medical equipment and specialized and/or trained team.…”

Section: Discussionmentioning

confidence: 99%

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Diagnósticos, resultados e intervenções de enfermagem em pacientes com lesão renal aguda

et al. 2017

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Objective: To identify prevalence and correlate diagnosis, results, and nursing interventions in patients with acute renal injury (ARI) who were hospitalized in an intensive care unit (ICU). Methods: This was a cross-sectional study including 98 patients older than 18 years old with ARI who were undergoing hemodialysis treatment in the ICU . The study was carried out in an ICU a large public hospital located in the city of São Paulo, Brazil. For statistics analysis we used the SPSS v21.0 to estimate prevalence, the 95% of confidence interval and sample error of 0.05. Data were collected from March to July 2016 using structured interviews, anamnesis and physical exam of patients using an instrument designed by this study researchers. The main instrument was completed by the principal researcher. Nursing consultation lasted for approximately 30 minutes. Of the total sample, 10% was selected and checked randomly in order to evaluate data quality and atypical values. Two patients previously did a pilot test to verify whether information in the instrument achieved the objective of the study. Results: The 98 participatns were aged ≥60 years (33%), men (60%), and classified as pre-renal injury (54%). Prevalent diagnosis was (100%) risk of infection, risk of inefficient gastrointestinal perfusion, risk of ineffective renal perfusion, risk of electrolyte imbalance, excessive fluid volume, and risk of imbalanced fluid volume. Results (100%) were: severity of infection, access for hemodialysis, tissue perfusionabdominal organs, hydric balance, mobility, removal of toxins and renal function. Prevalent nursing interventions (100%) were: promotion against infection, control of infection, maintenance of access for dialysis, hydroeletrolitic control, urinary elimination control, acid-base control, electrolytic control, hypervolemia control, hydric control, hydric monitoring, respiratory physiotherapy, respiratory and positioning monitoring. Correlations were significant (p< 0.001) between diagnosis and nursing interventions and between nursing interventions and results. Conclusion: Main diagnosis, results and nursing interventions related with loss of renal function originated from changes of renal perfusion, volemia, hydroelectrolytic dysfunctions, and risk of infection. The number of diagnosis showed to be correlated with number of nursing interventions and nursing interventions was correlated with results. ResumoObjetivo: Identificar prevalência de diagnósticos (DE), resultados (RE) e intervenções de enfermagem (IE) em pacientes com lesão renal aguda (LRA) internados em unidade de terapia intensiva (UTI). Correlacionar DE, RE e IE identificados. Métodos: Estudo transversal, conduzido em Unidades de Terapia Intensiva de um hospital público de grande porte da cidade de São Paulo. Foram incluídos, numa amostra intencional, 98 pacientes com LRA em tratamento hemodialítico internados em UTI, maiores de 18 anos. Foi utilizado software SPSS v21.0 para estimação da prevalência, fixando a estimativa no intervalo de confiança ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnósticos, resultados e intervenções de enfermagem em pacientes com lesão renal aguda

et al. 2017

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“…AKI is also a frequent complication and affects up to 2/3 of patients with hematologic malignancies admitted to ICUs. The etiology of AKI is multifactorial and is also an independent risk factor for death within this scenario [45–47]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes from a cohort of patients with acute kidney injury subjected to continuous venovenous hemodiafiltration: The role of negative fluid balance

et al. 2017

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BackgroundSeveral factors influence the outcomes in acute kidney injury (AKI), especially in intensive care unit (ICU) patients. In this scenario, continuous renal replacement therapies (CRRT) are used to control metabolic derangements and blood volume. Knowing this fact, it may be possible to change the course of the disease and decrease the high mortality rate observed. Thus, we aimed to evaluate the main risk factors for death in AKI patients needing CRRT.ResultsThis was a prospective, observational cohort study of ICU patients (N = 183) with AKI who underwent continuous venovenous hemodiafiltration (CVVHDF) as their initial dialysis modality choice. The patients were predominantly male (62.8%) and their median age was 65 (55–76) years. The most frequent comorbidities were cardiovascular disease (39.3%), hypertension (32.8%), diabetes (24%), and cirrhosis (20.7%). The main cause of AKI was sepsis (52.5%). At beginning of CVVHDF, 152 patients (83%) were using vasopressors. The median SAPS 3 and SOFA score at ICU admission was 61 (50–74) and 10 (7–12), respectively. The dialysis dose delivered was 33.2 (28.9–38.7) ml/kg/h. The median time between ICU admission and CVVHDF initiation was 2 (1–4) days. The median cumulative fluid balance during the CVVHDF period was -1838 (-5735 +2993) ml. The mortality rate up to90 days was 58%. The independent mortality risk factors in propensity score model were: chronic obstructive pulmonary disease (OR = 3.44[1.14–10.4; p = 0.028]), hematologic malignancy (OR = 5.14[1.66–15.95; p = 0.005]), oliguria (OR = 2.36[1.15–4.9; p = 0.02]), positive daily fluid balance during CVVHDF (OR = 4.55[2.75–13.1; p<0.001]), and total SOFA score on first dialysis day (OR = 1.27[1.12–1.45; p<0.001]).ConclusionsDialysis-related factors may influence the outcomes. In our cohort, positive daily fluid balance during CRRT was associated with lower survival. Multicenter, randomized studies are needed to assess fluid balance as a primary outcome to define the best strategy in this patient population.

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“…The adverse outcomes of SPRINT should not be overlooked lightly, especially because hypotension and acute kidney disease are associated with their own morbidity and mortality. 7,8 In particular, low blood pressure and syncope may predispose to falls and dizziness, especially in the elderly, 7 and acute renal injury/failure is now recognized as an important risk factor for new onset chronic kidney disease and acceleration in progression to end-stage renal disease, 8,9 with its own challenges of poor quality of life, disability, and longterm costs of care. 8,9 Hence, although we may prevent overall cardiovascular events by treating hypertensive patients to a target of <120 mm Hg, as suggested by SPRINT, this needs to be considered in the context that we may be creating new morbidities linked to electrolyte imbalances (predisposing to cardiac arrhythmias), hypotension, and renal disease.…”

Section: -5mentioning

confidence: 99%