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Article: Chloride in intensive care units: a key electrolyte.

Bandak, Ghassan / Kashani, Kianoush B

2017 Volume 6, Page(s) 1930

Abstract: Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are ... ...

Abstract	Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are disease-related; others, treatment-related. Chloride abnormalities were shown in animal models to have adverse effects on arterial blood pressure, renal blood flow, and inflammatory markers, which have led to several clinical investigations. Hyperchloremia was studied in several settings and correlated to different outcomes, including death and acute kidney injury. Baseline hypochloremia, to a much lesser extent, has been studied and associated with similar outcomes. The chloride content of resuscitation fluids was also a subject of clinical research. In this review, we describe the effect of dyschloremia on outcomes in critically ill patients. We review the major studies assessing the chloride content of resuscitation fluids in the critically ill patient.
Language	English
Publishing date	2017
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2699932-8
ISSN	2046-1402
ISSN	2046-1402
DOI	10.12688/f1000research.11401.1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Kidney-Related Outcomes After Hospital-Associated Acute Kidney Injury: Even the Mildest Episodes Count.

Bandak, Ghassan / Grams, Morgan E

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

2016 Volume 67, Issue 5, Page(s) 716–718

MeSH term(s)	Acute Kidney Injury ; Humans ; Kidney ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Comment ; Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2016.02.030
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Article ; Online: Chloride in intensive care units

Ghassan Bandak / Kianoush B. Kashani

F1000Research, Vol

a key electrolyte [version 1; referees: 3 approved]

2017 Volume 6

Abstract	Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are disease-related; others, treatment-related. Chloride abnormalities were shown in animal models to have adverse effects on arterial blood pressure, renal blood flow, and inflammatory markers, which have led to several clinical investigations. Hyperchloremia was studied in several settings and correlated to different outcomes, including death and acute kidney injury. Baseline hypochloremia, to a much lesser extent, has been studied and associated with similar outcomes. The chloride content of resuscitation fluids was also a subject of clinical research. In this review, we describe the effect of dyschloremia on outcomes in critically ill patients. We review the major studies assessing the chloride content of resuscitation fluids in the critically ill patient.
Keywords	Acute Renal Failure ; Renal Function & Transport Physiology ; Renal & Gastrointestinal Problems in Critical Care ; Medicine ; R ; Science ; Q
Subject code	616 ; 610
Language	English
Publishing date	2017-11-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Severe Metabolic Acidosis: A Case of Triple Hit with Ketogenic Diet, Vinegar, and Metformin in an Obese Patient.

Rana, Abdul Mughees / Mansoor, Kannan / Assad, Salman / Abouzid, Mahmoud / Ogu, Iheanyichukwu / Bandak, Ghassan Salim Issa

Case reports in nephrology

2020 Volume 2020, Page(s) 8861978

Abstract: Obesity is an epidemic with high burden of disease. It is directly proportional to increased risk of morbidity and mortality. Ketogenic diet and herbal supplements have recently gained popularity amongst patients struggling with weight loss. There are ... ...

Abstract	Obesity is an epidemic with high burden of disease. It is directly proportional to increased risk of morbidity and mortality. Ketogenic diet and herbal supplements have recently gained popularity amongst patients struggling with weight loss. There are limited data available for most of these supplements contrary to the claims laid by the mainstream media. Due to lack of awareness, this patient population is at high risk of adverse effects. We present a case of severe acidosis secondary to ketogenic diet and acetic acid (vinegar) ingestion. The use of dietary acetic acid is usually well tolerated; however, in this case, the large quantities and presence of acute renal injury may have worsened the acidosis. Severe ketosis in setting of ketogenic diets is a serious complication, which is infrequently reported in literature. Many of these diets and supplements may seem harmless, but as our case illustrates, when combined with other risk factors, patients can face adverse effects and even hospitalization. It is imperative that such dietary practices are physician supervised to avoid complications. With the recent surge of over-the-counter weight loss supplements and fat diets, physicians need to engage in dietary discussion with patients when attempting to lose weight.
Language	English
Publishing date	2020-09-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627652-5
ISSN	2090-665X ; 2090-6641
ISSN (online)	2090-665X
ISSN	2090-6641
DOI	10.1155/2020/8861978
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Article ; Online: Use of diuretics in shock: Temporal trends and clinical impacts in a propensity-matched cohort study.

Bandak, Ghassan / Sakhuja, Ankit / Andrijasevic, Nicole M / Gunderson, Tina M / Gajic, Ognjen / Kashani, Kianoush

PloS one

2020 Volume 15, Issue 2, Page(s) e0228274

Abstract: Objective: Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement ... ...

Abstract	Objective: Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement therapies (RRT) among patients who receive vasopressors. Patients and methods: This is a single-center retrospective study of all adult patients admitted to the intensive care unit between January 2006 and December 2016 and received >6 hours of vasopressor therapy and at least one concomitant dose of diuretic. We excluded patients from cardiac care units. Hourly urine output and vasopressor dose for 6 hours before and after the first dose of diuretic therapy was compared. Rates of AKI development and RRT initiation were assessed with a propensity-matched cohort of patients who received vasopressors but did not receive diuretics. Results: There was an increasing trend of prescribing diuretics in patients receiving vasopressors over the course of the study. We included 939 patients with median (IQR) age of 68(57, 78) years old and 400 (43%) female. The average hourly urine output during the first six hours following time zero in comparison with average hourly urine output during the six hours prior to time zero was significantly higher in diuretic group in comparison with patients who did not receive diuretics [81 (95% CI 73-89) ml/h vs. 42 (95% CI 39-45) ml/h, respectively; p<0.001]. After propensity matching, the rate of AKI within 7 days of exposure and the need for RRT were similar between the study and matched control patients (66 (15.6%) vs. 83 (19.6%), p = 0.11, and 34 (8.0%) vs. 37 (8.7%), p = 0.69, respectively). Mortality, however, was higher in the group that received diuretics. Ninety-day mortality was 191 (45.2%) in the exposed group VS 156 (36.9%) p = .009. Conclusions: While the use of diuretic therapy in critically ill patients receiving vasopressor infusions augmented urine output, it was not associated with higher vasopressor requirements, AKI incidence, and need for renal replacement therapy.
MeSH term(s)	Acute Kidney Injury/complications ; Aged ; Cohort Studies ; Critical Illness ; Diuretics/pharmacology ; Drug Interactions ; Female ; Humans ; Male ; Middle Aged ; Renal Replacement Therapy ; Retrospective Studies ; Shock/complications ; Shock/drug therapy ; Shock/physiopathology ; Shock/urine ; Treatment Outcome ; Vasoconstrictor Agents/pharmacology ; Vasoconstrictor Agents/therapeutic use
Chemical Substances	Diuretics ; Vasoconstrictor Agents
Language	English
Publishing date	2020-02-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0228274
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Article ; Online: Bilateral Pulmonary Embolism associated with Varicella Zoster Meningoencephalitis in an Immunocompetent Adult

Alexandra Gillispie / Sofanit Dessie / Rodrigo Aguilar / Kemnasom Nwanwene / Ghassan Bandak / Elie Khalil / Imran Khawaja

Marshall Journal of Medicine, Vol 6, Iss 4, Pp 33-

A case report and literature review

2020 Volume 38

Abstract: Association of Varicella Zoster Virus (VZV) with a considerable variety of complications has been well documented throughout literature. Primary infection, most often seen in children, is generally characterized by mild symptoms, as opposed to the more ... ...

Abstract	Association of Varicella Zoster Virus (VZV) with a considerable variety of complications has been well documented throughout literature. Primary infection, most often seen in children, is generally characterized by mild symptoms, as opposed to the more severe presentations in adult and immunocompromised populations. Manifestations of disseminated VZV include dermatologic, pulmonary, neurologic, and ocular involvement. Vascular and hematologic complications are also reported and sometimes pose serious health threat. We present an interesting case of disseminated VZV infection, complicated by meningitis, encephalitis, and bilateral pulmonary embolism in an otherwise immunocompetent 52-year-old man with no prior chicken pox exposure.
Keywords	varicella ; pulmonary embolism ; lupus anticoagulant ; Medicine (General) ; R5-920
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	Marshall University
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Use of diuretics in shock

Ghassan Bandak / Ankit Sakhuja / Nicole M Andrijasevic / Tina M Gunderson / Ognjen Gajic / Kianoush Kashani

PLoS ONE, Vol 15, Iss 2, p e

Temporal trends and clinical impacts in a propensity-matched cohort study.

2020 Volume 0228274

Abstract: OBJECTIVE:Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement ... ...

Abstract	OBJECTIVE:Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement therapies (RRT) among patients who receive vasopressors. PATIENTS AND METHODS:This is a single-center retrospective study of all adult patients admitted to the intensive care unit between January 2006 and December 2016 and received >6 hours of vasopressor therapy and at least one concomitant dose of diuretic. We excluded patients from cardiac care units. Hourly urine output and vasopressor dose for 6 hours before and after the first dose of diuretic therapy was compared. Rates of AKI development and RRT initiation were assessed with a propensity-matched cohort of patients who received vasopressors but did not receive diuretics. RESULTS:There was an increasing trend of prescribing diuretics in patients receiving vasopressors over the course of the study. We included 939 patients with median (IQR) age of 68(57, 78) years old and 400 (43%) female. The average hourly urine output during the first six hours following time zero in comparison with average hourly urine output during the six hours prior to time zero was significantly higher in diuretic group in comparison with patients who did not receive diuretics [81 (95% CI 73-89) ml/h vs. 42 (95% CI 39-45) ml/h, respectively; p<0.001]. After propensity matching, the rate of AKI within 7 days of exposure and the need for RRT were similar between the study and matched control patients (66 (15.6%) vs. 83 (19.6%), p = 0.11, and 34 (8.0%) vs. 37 (8.7%), p = 0.69, respectively). Mortality, however, was higher in the group that received diuretics. Ninety-day mortality was 191 (45.2%) in the exposed group VS 156 (36.9%) p = .009. CONCLUSIONS:While the use of diuretic therapy in critically ill patients receiving vasopressor infusions augmented urine output, it was not associated with higher vasopressor requirements, AKI ...
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Role of Loop Diuretic Challenge in Stage 3 Acute Kidney Injury.

Sakhuja, Ankit / Bandak, Ghassan / Barreto, Erin F / Vallabhajosyula, Saraschandra / Jentzer, Jacob / Albright, Robert / Kashani, Kianoush B

Mayo Clinic proceedings

2019 Volume 94, Issue 8, Page(s) 1509–1515

Abstract: Objective: To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3.: Patients and methods: Adult patients admitted to intensive care units between January 1, 2004, ... ...

Abstract	Objective: To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3. Patients and methods: Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours. Results: Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively. Conclusion: Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.
MeSH term(s)	Academic Medical Centers ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy ; Adult ; Age Factors ; Aged ; Area Under Curve ; Cohort Studies ; Critical Illness/mortality ; Critical Illness/therapy ; Female ; Humans ; Intensive Care Units ; Kidney Function Tests ; Male ; Middle Aged ; Patient Selection ; Prognosis ; Renal Dialysis/methods ; Retrospective Studies ; Risk Assessment ; Sex Factors ; Sodium Potassium Chloride Symporter Inhibitors/administration & dosage ; Survival Rate ; Treatment Outcome ; Urination/physiology
Chemical Substances	Sodium Potassium Chloride Symporter Inhibitors
Language	English
Publishing date	2019-07-03
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2019.01.040
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Article ; Online: Hyperuricemia after orthotopic liver transplantation: divergent associations with progression of renal disease, incident end-stage renal disease, and mortality.

Longenecker, Joseph C / Waheed, Sana / Bandak, Ghassan / Murakami, Christine A / McMahon, Blaithin A / Gelber, Allan C / Atta, Mohamed G

BMC nephrology

2017 Volume 18, Issue 1, Page(s) 103

Abstract: Background: Although hyperuricemia is common after orthotopic liver transplantation (OLT), its relationship to mortality, progressive kidney disease, or the development of end stage renal disease (ESRD) is not well-described.: Methods: Data from 304 ... ...

Abstract	Background: Although hyperuricemia is common after orthotopic liver transplantation (OLT), its relationship to mortality, progressive kidney disease, or the development of end stage renal disease (ESRD) is not well-described. Methods: Data from 304 patients undergoing OLT between 1996 and 2010 were used to assess the association of mean serum uric acid (UA) level in the 3-months post-OLT with mortality, doubling of creatinine, and ESRD incidence. Post-OLT survival to event outcomes according to UA level and eGFR was assessed using the Kaplan Meier method and multivariate Cox proportional hazards models. Results: Mean UA level among the 204 patients with an eGFR level ≥60 ml/min/1.73 m Conclusion: In this post-OLT cohort, hyperuricemia independently predicted mortality, particularly among patients with eGFR < 60, and predicted doubling of creatinine among diabetics.
MeSH term(s)	Adult ; Creatinine/metabolism ; Disease Progression ; Female ; Glomerular Filtration Rate ; Humans ; Hyperuricemia/epidemiology ; Hyperuricemia/metabolism ; Incidence ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/metabolism ; Liver Failure/surgery ; Liver Transplantation ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; Proportional Hazards Models ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/metabolism ; Retrospective Studies ; Risk Factors ; Survival Rate ; Uric Acid/metabolism
Chemical Substances	Uric Acid (268B43MJ25) ; Creatinine (AYI8EX34EU)
Language	English
Publishing date	2017-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-017-0518-5
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Article: Rituximab for the treatment of refractory simultaneous anti-glomerular basement membrane (anti-GBM) and membranous nephropathy.

Bandak, Ghassan / Jones, Bruce A / Li, Jian / Yee, Jerry / Umanath, Kausik

Clinical kidney journal

2014 Volume 7, Issue 1, Page(s) 53–56

Abstract: Antibody-mediated anti-glomerular basement membrane (anti-GBM) disease occurs rarely in the presence of another B-cell disorder, membranous nephropathy. The coexistence of these two autoimmune disorders would be anticipated to require differing, specific ...

Abstract	Antibody-mediated anti-glomerular basement membrane (anti-GBM) disease occurs rarely in the presence of another B-cell disorder, membranous nephropathy. The coexistence of these two autoimmune disorders would be anticipated to require differing, specific therapies targeted to each disease process. We describe a case of concomitant membranous nephropathy and anti-GBM disease in which conventional therapy, including steroids, plasmapheresis and cyclophosphamide, failed to attenuate the anti-GBM disease, yet responded to an alternative treatment of rituximab. This B-cell directed, monoclonal, chimeric antibody treatment substantially reduced anti-GBM antibody titers and led to discontinuation of plasmapheresis, while maintaining the remission of membranous nephropathy and anti-GBM disease.
Language	English
Publishing date	2014-01-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sft152
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