1,720,998 research outputs found
Remote Monitoring for the Wearable Artificial Kidney
No full textRecent technological advances have led to the construction of a truly wearable artificial kidney (WAK). This device offers the promise of regulation of volume status and provision of adequate solute clearances, while at the same time allowing its user to receive continuous therapy while going on with the normal activities of daily life. An important component of such a therapy is the ability to remotely monitor the treatment. This remote monitoring allows assurance of patient safety through surveillance of critical portions of the treatment as well as the ability to monitor compliance with prescribed therapy and automated collection of treatment data. Recent advances in telemedicine, telemonitoring, remote network access and sensor technologies have made such remote monitoring of the WAK feasible. Furthermore, experience with remote monitoring for nocturnal hemodialysis, which shares some similarities with the needs of the WAK for monitoring, can guide implementation of such a system. Copyright (C) 2011 S. Karger AG, Base
Dysnatremias in the Intensive Care Unit
No full textDysnatremias (hypo- and hypernatremia) are common in patients admitted to the intensive care unit (ICU) with a prevalence approaching 20-30% in some studies. Recent data reveals that both hypo- and hypernatremia present on admission to or developing in the ICU are independent risk factors for poor prognosis. The origin of hypernatremia in the ICU is often iatrogenic and due to inadequate free water replacement of ongoing water losses. The pathogenesis of hyponatremia in the ICU is more complicated but often is related to the combination of dysregulated arginine vasopressin production and concomitant inappropriate hypotonic fluid administration. Both the dysnatremia itself and the treatment of the electrolyte disturbance can be associated with morbidity and mortality making careful monitoring for and treatment of sodium disorders an imperative in the critically ill patient. Formulae have been devised to guide the therapy of severe hypo- and hypernatremia, but these formulae regard the patient as a closed system and do not take into account ongoing fluid losses that can be highly variable. Thus, a cornerstone of proper therapy is serial measurements of serum and urine electrolytes. The appropriate use of hypertonic (3%) saline in the treatment of hyponatremic encephalopathy has also shown to be very effective and the use of this therapy is reviewed here. Vasopressin receptor antagonists have also been shown to be effective at increasing serum sodium levels in patients with either euvolemic or hypervolemic hyponatremia and represent another therapeutic option. Recent data demonstrates that proper correction of hyponatremia is associated with improved short- and long-term outcomes. Copyright (C) 2010 S. Karger AG, Base
The Role of Inflammation in the Cardio-Renal Syndrome: A Focus on Cytokines and Inflammatory Mediators
No full textCardiovascular and kidney diseases are highly prevalent and frequently are seen in the same patient. This overlap between cardiac and kidney diseases, in part, relates to common etiologies such as diabetes and hypertension. However, there are important dynamic and bidirectional interactions between the cardiovascular system and kidneys that may explain the occurrence of organ dysfunction. In this regard, it is clear that inflammation plays an important role in the pathogenesis of both cardiovascular and renal diseases. Given the circulating nature of many inflammatory mediators (cytokines, immune cells), it is tempting to speculate that the immune system can act as a mediator of organ cross-talk and may be involved in the reciprocal dysfunction that is encountered commonly in cardio-renal syndromes. Semin Nephrol 32:70-78 (C) 2012 Elsevier Inc. All rights reserved
Counteracting the Metabolic Effects of Glucose Load in Peritoneal Dialysis Patients; an Exercise-Based Approach
No full textGlucose-based peritoneal dialysis (PD) solutions are the predominantly used dialysate in PD patients. Glucose absorption has been shown to be associated with several unfavorable metabolic complications. Several studies have shown positive effects of exercise in end-stage renal disease patients. This paper provides an overview of glucose-associated metabolic complications, and proposed exercise regimens to counteract the caloric load associated with glucose absorption
Computerized decision support systems: improving patient safety in nephrology
No full textIncorrect prescription and administration of medications account for a substantial proportion of medical errors in the USA, causing adverse drug events (ADEs) that result in considerable patient morbidity and enormous costs to the health-care system. Patients with chronic kidney disease or acute kidney injury often have impaired drug clearance as well as polypharmacy, and are therefore at increased risk of experiencing ADEs. Studies have demonstrated that recognition of these conditions is not uniform among treating physicians, and prescribed drug doses are often incorrect. Early interventions that ensure appropriate drug dosing in this group of patients have shown encouraging results. Both computerized physician order entry and clinical decision support systems have been shown to reduce the rate of ADEs. Nevertheless, these systems have been implemented at surprisingly few institutions. Economic stimulus and health-care reform legislation present a rare opportunity to refine these systems and understand how they could be implemented more widely. Failure to explore this technology could mean that the opportunity to reduce the morbidity associated with ADEs is missed
Approach to Diagnosis and Treatment of Hypercalcemia in a Patient With Malignancy
No full textHypercalcemia is a common complication of malignancy and portends a worse prognosis. It causes a variety of symptoms in patients, which can range from confusion and polyuria to coma and death. There are 4 broad mechanistic categories to classify hypercalcemia of malignancy: local osteolysis secondary to metastatic cancer or multiple myeloma, excess parathyroid-related hormone, excess 1,25-dihydroxyvitamin D production, and ectopic parathyroid hormone production. Volume expansion with normal saline solution and treatment with intravenous bisphosphonates to decrease osteoclast-mediated bone destruction are effective initial therapies. Calcitonin, gallium nitrate, and corticosteroids can serve as adjunctive therapies. Denosumab is an attractive therapeutic option for refractory cases of hypercalcemia, although more data are required before this therapy can be recommended
The Role of Therapeutic Plasma Exchange in Poisonings and Intoxications
No full textPoisonings, intoxications, and drug overdoses are common occurrences and rapid lowering of the toxin level is a cornerstone of all effective therapies. Therapeutic plasma exchange (TPE) has several unique characteristics that allow it to be a potentially effective therapy in rapidly achieving this goal. Specifically, TPE allows for the removal of large molecular weight, protein-bound molecules that have a small volume of distribution. Due to the nature of poisonings, intoxications, and drug overdoses, no randomized controlled trials studying the efficacy of TPE in these situations exist. Thus, careful interpretation and analysis of case reports and series are required to assess the potential efficacy of this therapy. Recent data suggest that TPE may also be effective in the therapy of patients receiving biologic treatments who develop life-threatening complications due to therapy
Acute kidney injury in elderly intensive care patients: a review
No full textThe elderly are at high risk for acute kidney injury (AKI). With the aging of the population, the demand for intensive care unit (ICU) admission from older patients will continue to rise, and this clinical entity will likely become increasingly common. In this article we review the relevant literature, discuss the age-related changes that render older people prone to AKI development, and examine the most frequent etiologies for renal impairment in these patients. We also consider the difficulties in achieving an early diagnosis in the elderly ICU patient, the particularities related to AKI treatment in this age group, and the data available on differences in renal recovery and mortality between the young and the old with renal injury. More importantly, we highlight the methods for prevention of AKI development or worsening in the elderly critically ill patient
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