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  1. Article ; Online: Recurrent Polyuria.

    Arora, Nayan / Durvasula, Raghu

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2018  Volume 72, Issue 5, Page(s) A17–A19

    MeSH term(s) Anemia, Aplastic/diagnosis ; Anemia, Aplastic/surgery ; Bacteremia/complications ; Bacteremia/microbiology ; Bacteremia/therapy ; Blood Chemical Analysis ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cell Transplantation/methods ; Humans ; Klebsiella Infections/complications ; Klebsiella Infections/diagnosis ; Klebsiella Infections/drug therapy ; Male ; Middle Aged ; Mycoses/complications ; Mycoses/diagnosis ; Mycoses/drug therapy ; Polyuria/etiology ; Polyuria/therapy ; Postoperative Complications/physiopathology ; Postoperative Complications/therapy ; Recurrence ; Sinusitis/complications ; Sinusitis/diagnosis ; Treatment Outcome
    Language English
    Publishing date 2018-10-02
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2018.07.006
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  2. Article ; Online: COVID-19 and Kidney Failure in the Acute Care Setting: Our Experience From Seattle.

    Durvasula, Raghu / Wellington, Tracy / McNamara, Elizabeth / Watnick, Suzanne

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2020  Volume 76, Issue 1, Page(s) 4–6

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Disease Management ; Disease Transmission, Infectious/prevention & control ; Humans ; Incidence ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; Renal Insufficiency/epidemiology ; Renal Insufficiency/etiology ; Renal Insufficiency/therapy ; Renal Replacement Therapy/standards ; SARS-CoV-2 ; Washington/epidemiology
    Keywords covid19
    Language English
    Publishing date 2020-04-08
    Publishing country United States
    Document type Editorial
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2020.04.001
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  3. Article ; Online: Management of Patients with Multidrug-Resistant Organisms in Outpatient Dialysis Facilities.

    Dittrich, Mary / Silberzweig, Jeffrey / Hymes, Jeffrey L / Giullian, Jeff / Green, Gopa / Wong, Leslie P / Freedman, Barry I / Bhat, J Ganesh / Spry, Leslie / Taylor, Robert / Spech, Richard / Durvasula, Raghu / Blue, Sky R

    Clinical journal of the American Society of Nephrology : CJASN

    2023  

    Language English
    Publishing date 2023-12-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.0000000000000419
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  5. Article ; Online: COVID-19 and Kidney Failure in the Acute Care Setting

    Durvasula, Raghu / Wellington, Tracy / McNamara, Elizabeth / Watnick, Suzanne

    American Journal of Kidney Diseases

    Our Experience From Seattle

    2020  Volume 76, Issue 1, Page(s) 4–6

    Keywords Nephrology ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2020.04.001
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  6. Article ; Online: Collaboration between Dialysis Providers.

    Silberzweig, Jeffrey / Bhat, J Ganesh / Dittrich, Mary O / Durvasula, Raghu / Giullian, Jeff / Hymes, Jeffrey L / Johnson, Doug / Schiller, Brigitte / Spech, Richard / Spry, Leslie / Walker, Geoffrey Scott / Watnick, Suzanne / Yee, Jerry / Freedman, Barry I

    Journal of the American Society of Nephrology : JASN

    2022  Volume 33, Issue 8, Page(s) 1440–1444

    MeSH term(s) Humans ; Kidney Failure, Chronic/therapy ; Renal Dialysis
    Language English
    Publishing date 2022-06-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2021111475
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  7. Article: Standardized Review and Approval Process for High-Cost Medication Use Promotes Value-Based Care in a Large Academic Medical System.

    Durvasula, Raghu / Kelly, Janet / Schleyer, Anneliese / Anawalt, Bradley D / Somani, Shabir / Dellit, Timothy H

    American health & drug benefits

    2018  Volume 11, Issue 2, Page(s) 65–73

    Abstract: Background: As healthcare costs rise and reimbursements decrease, healthcare organization leadership and clinical providers must collaborate to provide high-value healthcare. Medications are a key driver of the increasing cost of healthcare, largely as ... ...

    Abstract Background: As healthcare costs rise and reimbursements decrease, healthcare organization leadership and clinical providers must collaborate to provide high-value healthcare. Medications are a key driver of the increasing cost of healthcare, largely as a result of the proliferation of expensive specialty drugs, including biologic agents. Such medications contribute significantly to the inpatient diagnosis-related group payment system, often with minimal or unproved benefit over less-expensive therapies.
    Objective: To describe a systematic review process to reduce non-evidence-based inpatient use of high-cost medications across a large multihospital academic health system.
    Methods: We created a Pharmacy & Therapeutics subcommittee consisting of clinicians, pharmacists, and an ethics representative. This committee developed a standardized process for a timely review (<48 hours) and approval of high-cost medications based on their clinical effectiveness, safety, and appropriateness. The engagement of clinical experts in the development of the consensus-based guidelines for the use of specific medications facilitated the clinicians' acceptance of the review process.
    Results: Over a 2-year period, a total of 85 patient-specific requests underwent formal review. All reviews were conducted within 48 hours. This review process has reduced the non-evidence-based use of specialty medications and has resulted in a pharmacy savings of $491,000 in fiscal year 2016, with almost 80% of the savings occurring in the last 2 quarters, because our process has matured.
    Conclusion: The creation of a collaborative review process to ensure consistent, evidence-based utilization of high-cost medications provides value-based care, while minimizing unnecessary practice variation and reducing the cost of inpatient care.
    Language English
    Publishing date 2018-06-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2853721-X
    ISSN 1942-2970 ; 1942-2962
    ISSN (online) 1942-2970
    ISSN 1942-2962
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  8. Article: Activation of a local renin angiotensin system in podocytes by glucose.

    Durvasula, Raghu V / Shankland, Stuart J

    American journal of physiology. Renal physiology

    2008  Volume 294, Issue 4, Page(s) F830–9

    Abstract: ANG II is a critical mediator of diabetic nephropathy. Pharmacologic inhibition of ANG II slows disease progression beyond what could be predicted by the blood pressure lowering effects alone, suggesting the importance of nonhemodynamic pathways of ANG ... ...

    Abstract ANG II is a critical mediator of diabetic nephropathy. Pharmacologic inhibition of ANG II slows disease progression beyond what could be predicted by the blood pressure lowering effects alone, suggesting the importance of nonhemodynamic pathways of ANG II in mediating disease. Podocyte injury and loss are cardinal features of diabetic nephropathy. Mounting evidence suggests that the podocyte is a direct target of ANG II-mediated signaling in diabetic renal disease. We have tested the hypothesis that high glucose leads to the activation of a local angiotensin system in podocytes and delineated the underlying pathways involved. Cultured podocytes were exposed to standard glucose (5 mM), high glucose (40 mM), or mannitol as an osmotic control. ANG II levels in cell lysates were measured in the presence or absence of inhibitors of angiotensin-converting enzyme (captopril), chymase (chymostatin), and renin (aliskiren) activity. The effects of glucose on renin and angiotensin subtype 1 receptor expression and protein levels were determined. Exposure to high glucose resulted in a 2.1-fold increase ANG II levels mediated through increased renin activity, as exposure to high glucose increased renin levels and preincubation with Aliskiren abrogated glucose-induced ANG II production. Relevance to the in vivo setting was demonstrated by showing glomerular upregulation of the prorenin receptor in a podocyte distribution early in the course of experimental diabetic nephropathy. Furthermore, high glucose increased angiotensin subtype 1 receptor levels by immunofluorescence and Western blot. Taken together, the resultant activation of a local renin angiotensin system by high glucose may promote progressive podocyte injury and loss in diabetic nephropathy.
    MeSH term(s) Angiotensin II/genetics ; Angiotensin II/pharmacology ; Angiotensin II/physiology ; Animals ; Cells, Cultured ; DNA Primers ; Diabetic Nephropathies/etiology ; Diabetic Nephropathies/physiopathology ; Glucose/pharmacology ; Kidney/drug effects ; Kidney/physiology ; Kidney/physiopathology ; Mice ; Podocytes/cytology ; Podocytes/drug effects ; Podocytes/physiology ; Polymerase Chain Reaction ; RNA, Messenger/genetics ; Renin/genetics ; Renin-Angiotensin System/drug effects ; Renin-Angiotensin System/physiology
    Chemical Substances DNA Primers ; RNA, Messenger ; Angiotensin II (11128-99-7) ; Renin (EC 3.4.23.15) ; Glucose (IY9XDZ35W2)
    Language English
    Publishing date 2008-04
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 603837-2
    ISSN 1522-1466 ; 1931-857X ; 0363-6127
    ISSN (online) 1522-1466
    ISSN 1931-857X ; 0363-6127
    DOI 10.1152/ajprenal.00266.2007
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  9. Article: The renin-angiotensin system in glomerular podocytes: mediator of glomerulosclerosis and link to hypertensive nephropathy.

    Durvasula, Raghu V / Shankland, Stuart J

    Current hypertension reports

    2006  Volume 8, Issue 2, Page(s) 132–138

    Abstract: The renoprotective effects of pharmacologic inhibition of angiotensin II extend beyond the blood pressure-lowering effects alone, consistent with the observation that angiotensin II is produced locally within the kidney and mediates tissue injury through ...

    Abstract The renoprotective effects of pharmacologic inhibition of angiotensin II extend beyond the blood pressure-lowering effects alone, consistent with the observation that angiotensin II is produced locally within the kidney and mediates tissue injury through a series of nonhemodynamic effects. Podocytes are terminally differentiated epithelial cells that contribute to the filtration barrier of the kidney, but also safeguard against the development of glomerulosclerosis. Mounting evidence demonstrates that podocytes are not only a local source of angiotensin II production, but are also vulnerable to its deleterious effects, thus fueling the future development of glomerular scarring. In this review article, we explore the role of a local angiotensin system as a mediator of podocyte injury and discuss its potential link to hypertensive renal disease.
    MeSH term(s) Angiotensin II/metabolism ; Glomerulonephritis/etiology ; Glomerulonephritis/metabolism ; Glomerulosclerosis, Focal Segmental/complications ; Glomerulosclerosis, Focal Segmental/metabolism ; Glomerulosclerosis, Focal Segmental/pathology ; Humans ; Hypertension, Renal/etiology ; Hypertension, Renal/metabolism ; Kidney Glomerulus/metabolism ; Kidney Glomerulus/pathology ; Podocytes/metabolism ; Podocytes/pathology ; Renin-Angiotensin System
    Chemical Substances Angiotensin II (11128-99-7)
    Language English
    Publishing date 2006-05-04
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2057367-4
    ISSN 1522-6417
    ISSN 1522-6417
    DOI 10.1007/s11906-006-0009-8
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  10. Article ; Online: A quality improvement project to improve early sepsis care in the emergency department.

    Gatewood, Medley O'Keefe / Wemple, Matthew / Greco, Sheryl / Kritek, Patricia A / Durvasula, Raghu

    BMJ quality & safety

    2015  Volume 24, Issue 12, Page(s) 787–795

    Abstract: Background: Sepsis causes substantial morbidity and mortality in hospitalised patients. Although many studies describe the use of protocols in the management of patients with severe sepsis and septic shock, few have addressed emergency department (ED) ... ...

    Abstract Background: Sepsis causes substantial morbidity and mortality in hospitalised patients. Although many studies describe the use of protocols in the management of patients with severe sepsis and septic shock, few have addressed emergency department (ED) screening and management for patients initially presenting with uncomplicated sepsis (ie, patients without organ failure or hypotension).
    Objective: A quality improvement task force at a large, quaternary care referral hospital sought to develop a protocol focusing on early identification of patients with uncomplicated sepsis, in addition to severe sepsis and septic shock.
    Intervention: The three-tiered intervention consisted of (1) a nurse-driven screening tool and management protocol to identify and initiate early treatment of patients with sepsis, (2) a computer-assisted screening algorithm that generated a 'Sepsis Alert' pop-up screen in the electronic medical record for treating clinical healthcare providers and (3) automated suggested sepsis-specific order sets for initial workup and resuscitation, antibiotic selection and goal-directed therapy.
    Design: A before and after retrospective cohort study was undertaken to determine the intervention's impact on compliance with recommended sepsis management, including serum lactate measured in the ED, 2 L of intravenous fluid administered within 2 h of triage, antibiotics administered within 3 h of triage and blood cultures drawn before antibiotic administration. Mortality rates for patients in the ED with a sepsis-designated ICD-9 code present on admission were also analysed.
    Results: Overall bundle compliance increased by 154%, from 28% at baseline to 71% in the last quarter of the study (p<0.001). Bundle, antibiotic and intravenous fluid compliance all increased significantly after launch of the sepsis initiative (eg, bundle and intravenous fluid compliance increased by 74% and 54%, respectively; p<0.001). Bundle and antibiotic compliance both showed further significant increases after implementation of suggested order sets (31% and 25% increases, respectively; p<0.001). The mortality rate for patients in the ED admitted with sepsis was 13.3% before implementation and fell to 11.1% after (p=0.230); mortality in the last two quarters of the study was 9.3% (p=0.107).
    Conclusions: The new protocol demonstrates that early screening interventions can lead to expedited delivery of care to patients with sepsis in the ED and could serve as a model for other facilities. Mortality was not significantly improved by our intervention, which included patients with uncomplicated sepsis.
    MeSH term(s) Algorithms ; Clinical Protocols ; Diagnosis, Computer-Assisted/methods ; Emergency Service, Hospital/organization & administration ; Guideline Adherence ; Humans ; Mass Screening/organization & administration ; Patient Care Bundles/methods ; Practice Guidelines as Topic ; Quality Improvement/organization & administration ; Resuscitation/methods ; Retrospective Studies ; Sepsis/diagnosis ; Sepsis/mortality ; Sepsis/therapy ; Shock, Septic/diagnosis ; Shock, Septic/therapy
    Language English
    Publishing date 2015-12
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2592912-4
    ISSN 2044-5423 ; 2044-5415
    ISSN (online) 2044-5423
    ISSN 2044-5415
    DOI 10.1136/bmjqs-2014-003552
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