1,721,031 research outputs found
Ultrafiltration in acute decompensated heart failure: friend or foe for the kidney?
No full textBackground: Congestion represents the common pathogenetic mechanism of both the acute decompensation episodes of heart failure and progression of the syndrome; it also increases the risk of rehospitalization, and is associated with renal function worsening. Diuretic therapy still represent the mainstay of therapy of congestion; however, ultrafiltration (i.e. fluid removal from blood by hemoconcentration obtained with dedicated machines) has been recently suggested as a more rapid and effective alternative to the conventional therapeutic approach. Methods: On the basis of the proposed mechanisms of action and rationale of ultrafiltration in heart failure, this review is aimed at discussing efficacy and safety issues of this mechanical modality of fluid removal, with special regard to renal function. Results: The available evidence, also including recent data from a randomized clinical trial comparing ultrafiltration with adequately managed diuretic therapy (the CARRESS study), does not support its extensive employment as an alternative to well protocolized conventional diuretic therapy, especially in patients with acute decompensated heart failure. As a matter of fact, in this latter case highly negative effects on renal function are also to be expected. Conclusion: Ultrafiltration should be reserved to very selected patients with advanced heart failure and true diuretic resistance, as part of a more complex strategy aiming at an adequate control of fluid retention
[Hyponatremia: from guidelines to clinical practice]
No full textThe publication, within a short time interval, of a consensus statement on the pathophysiology, diagnosis and treatment of hyponatremia by a panel of experts mainly from the US and of the European Guidelines on the same topic has marked an important step towards reducing the differences in the treatment of this frequent, and potentially fatal, electrolyte disorder. Within this framework, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE), and the European Dialysis and Transplantation Association-European Renal Association, represented by the European Renal Best Practice (ERBP), have developed these Guidelines for clinical practice, that are focused mainly on the diagnosis and the treatment of hyponatremia. In fact, they are the result of a tight collaboration between the three scientific societies involving those specialists with an elective interest for this electrolyte disorder. In addition to a rigorous methodological approach, a choice was made to provide a document focused on clinically relevant outcomes and useful for everyday practice. With respect to the original paper, this version of the Guidelines has been shortened and translated with a special view to the recommendations concerning the diagnosis and treatment of hyponatremia. It is preceded by an introduction underscoring the main targets of non-pharmacological treatment in acute severely symptomatic cases, specifically as regards the rate of correction of hyponatremia; subsequently, potential explanations for the discrepancies between the European Guidelines and the consensus statement by US experts concerning the use of vaptans are briefly discussed; the rationale and practical limitations in the clinical use of urea are analyzed in more detail
Specialized nutritional support interventions in critically ill patients on renal replacement therapy.
No full textPurpose of Review: Optimal nutritional requirements and nutrient intake composition for patients with acute kidney injury remain a partially unresolved issue. Targeting nutritional support to the actual protein and energy needs improves the clinical outcome of critically ill patients, yet very few data are currently available on this topic in acute kidney injury. In this specific clinical condition the risk for underfeeding and overfeeding may be increased by factors interfering on nutrient need estimation, such as rapidly changing body weight due to fluid balance variations, nutrient losses and hidden calorie sources from renal replacement therapy. Moreover, as acute kidney injury is now considered a kidney-centered inflammatory syndrome, the renoprotective role of specific pharmaconutrients with anti-inflammatory properties remains to be fully defined. This review is aimed at discussing recently published results concerning quantitative and qualitative aspects of the nutritional approach to acute kidney injury in critically ill patients. Recent Findings: Nutrient needs in patients with acute kidney injury can be difficult to estimate, and should be directly measured, especially in the ICU setting. In fact, recent findings suggest that hidden calorie sources not routinely taken into account-for example, calories from anticoagulants and replacement solutions for renal replacement therapy-could be quantitatively relevant in these patients. Moreover, recent experimental data indicate a possible role for some pharmaconutrients with anti-inflammatory effects (glutamine, and omega-3 fatty acids), in both the prevention of renal function worsening, and in the fostering of renal function recovery after an episode of acute kidney injury. Summary: Acute kidney injury includes a highly heterogeneous group of patients with widely varying nutrient needs and intakes. Nutritional requirements, in their quantitative and qualitative aspects, should be frequently assessed, individualized, and carefully integrated with renal replacement therapy, in order to avoid both underfeeding and overfeeding, as well as to exploit possible positive pharmacologic effects of specific nutrients
Balancing thromboembolic risk against vitamin K antagonist-related bleeding and accelerated calcification: is Fondaparinux the holy grail for end-stage renal disease patients with atrial fibrillation?
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Electrolytes and COVID-19: challenges and caveats in clinical research studies
No full textBackground The prognostic impact of electrolyte disorders in hospitalized COVID-19 patients is unclear.
Methods The study included all adult patients hospitalized for COVID-19 in four hospitals in Northern Italy between January
2020 and May 2021 with at least one serum potassium and sodium measurement performed within 3 days since admission.
Primary outcome was in-hospital death; secondary outcome was Intensive Care Unit (ICU) admission. A cause-specific Cox
proportional-hazards regression model was used for investigating the association between potassium and sodium (as either
categorical or continuous variables) and mortality or admission to ICU.
Results Analyses included 3,418 adult hospitalized COVID-19 patients. At multivariable analysis, both hyperkalemia (Hazard
Ratio, [HR] 1.833, 95% Confidence Interval [CI] 1.371–2.450) and sK above the median (K 5.1 vs 4.1 mmol/L: HR
1.523, 95% CI 1.295–1.798), and hypernatremia (HR 2.313, 95%CI 1.772–3.018) and sNa above the median (Na 149 vs 139
mmol/L: HR 1.442, 95% CI 1.234–1.686), were associated with in-hospital death, whereas hypokalemia and hyponatremia
were not. Hyponatremia was associated with increased hazard of ICU admission (HR 1.884, 95%CI 1.389–2.556).
Conclusions Electrolyte disorders detected at hospital admission may allow early identification of COVID-19 patients at
increased risk of adverse outcomes
Efficacy and safety of long-term tolvaptan treatment in a patient with SCLC and SIADH
No full textHyponatremia frequently occurs in patients with cancer and is mostly due to a syndrome of inappropriate antidiuresis caused by ectopic secretion of antidiuretic hormone (SIADH). Small cell lung cancer presents with SIADH in approximately 11%-15% of cases. Recently, a new class of drugs, vasopressin V2-receptor antagonists (vaptans), emerged as a promising treatment for SIADH, but efficacy and safety data in cancer patients are lacking. We present a case of SIADH, heralding small cell lung cancer and persisting after apparent complete remission of primary tumor following chemotherapy/radiotherapy, in a patient who underwent long-term treatment with tolvaptan without any serious adverse effects
Protein/Energy Debt in Critically Ill Children in the Pediatric Intensive Care Unit: Acute Kidney Injury As a Major Risk Factor
Full text linkAcute kidney injury (AKI) is common in pediatric intensive care unit (PICU) patients. In this clinical setting, the risk of protein-energy wasting is high because of the metabolic derangements of the uremic syndrome, the difficulties in nutrient needs estimation, and the possible negative effects of renal replacement therapy itself on nutrient balance. No specific guidelines on nutritional support in PICU patients with AKI are currently available. The present review is aimed at evaluating the role of AKI as a risk condition for inadequate protein/energy intake in these patients, on the basis of literature data on quantitative aspects of nutritional support in PICU. Current evidence suggests that a relevant protein/energy debt, a widely accepted concept in the literature on adult intensive care unit patients with its negative implications for patients' major outcomes, is also likely to develop in pediatric critically ill patients, and that AKI represents a key factor for its development
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