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  1. Book: Handbook of critical care nephrology

    Koyner, Jay L. / Topf, Joel M. / Lerma, Edgar V.

    2021  

    Author's details Jay L. Koyner, Joel M. Topf, Edgar V. Lerma
    Keywords Kidney Diseases ; Critical Care / methods ; Replacement Therapy
    Language English
    Size xxi, 657 Seiten, Illustrationen
    Publisher Wolters Kluwer
    Publishing place Philadelphia, PA
    Publishing country United States
    Document type Book
    Accompanying material Zugang zu ebook über Code
    HBZ-ID HT021009400
    ISBN 978-1-975144-09-8 ; 1-975144-09-0
    Database Catalogue ZB MED Medicine, Health

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  2. Article ; Online: Sepsis and Kidney Injury.

    Koyner, Jay L

    Contributions to nephrology

    2021  Volume 199, Page(s) 56–70

    Abstract: Clinical Background: Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in ... ...

    Abstract Clinical Background: Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in hospitalized patients. Epidemiology: Recent standardized, separate consensus definitions of sepsis and AKI have informed the epidemiology of these 2 distinct processes. While there is no consensus definition specific to sepsis-associated AKI, several studies have utilized the combined definitions of these two syndromes to identify those patients at the highest risk for adverse outcomes. Challenges: Prevention of sepsis-associated AKI is difficult in part because patients will often present for medical care with the sepsis-associated AKI already clinically apparent. Additionally, for those that do not have AKI on presentation the ability to detect injury early is limited by the imperfect current gold standard biomarkers serum creatinine and urine output. Prevention and Treatment: Despite these challenges, there has been increased investigation of novel biomarkers of AKI. Additionally, there has been intense investigation into the ideal care of patients with sepsis, AKI as well as sepsis-associated AKI. While there are limited specific therapeutic options outside of antibiotics for infections, several studies have investigated the use of care bundles to treat these syndromes. While there is continued investigation into novel therapeutics and the use of dialysis and extracorporeal modalities, these trials have failed to revolutionize clinical care. This review summarizes the current state of sepsis-associated AKI care and discusses strategies to improve care.
    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; Biomarkers ; Creatinine ; Humans ; Kidney ; Renal Dialysis/adverse effects ; Sepsis/complications ; Sepsis/therapy
    Chemical Substances Biomarkers ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2021-08-03
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ISSN 1662-2782 ; 0302-5144
    ISSN (online) 1662-2782
    ISSN 0302-5144
    DOI 10.1159/000517701
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Digital health utilities in acute kidney injury management.

    Kashani, Kianoush B / Koyner, Jay L

    Current opinion in critical care

    2023  Volume 29, Issue 6, Page(s) 542–550

    Abstract: Purpose of review: Acute kidney injury (AKI) is a highly prevalent clinical syndrome that substantially impacts patient outcomes. It is accepted by the clinical communities that the management of AKI is time-sensitive. Unfortunately, despite growing ... ...

    Abstract Purpose of review: Acute kidney injury (AKI) is a highly prevalent clinical syndrome that substantially impacts patient outcomes. It is accepted by the clinical communities that the management of AKI is time-sensitive. Unfortunately, despite growing proof of its preventability, AKI management remains suboptimal in community, acute care, and postacute care settings. Digital health solutions comprise various tools and models to improve care processes and patient outcomes in multiple medical fields. AKI development, progression, recovery, or lack thereof, offers tremendous opportunities for developing, validating, and implementing digital health solutions in multiple settings. This article will review the definitions and components of digital health, the characteristics of AKI that allow digital health solutions to be considered, and the opportunities and threats in implementing these solutions.
    Recent findings: Over the past two decades, the academic output related to the use of digital health solutions in AKI has exponentially grown. While this indicates the growing interest in the topic, most topics are primarily related to clinical decision support by detecting AKI within hospitals or using artificial intelligence or machine learning technologies to predict AKI within acute care settings. However, recently, projects to assess the impact of digital health solutions in more complex scenarios, for example, managing nephrotoxins among adults of pediatric patients who already have AKI, is increasing. Depending on the type of patients, chosen digital health solution intervention, comparator groups, and selected outcomes, some of these studies showed benefits, while some did not indicate additional gain in care processes or clinical outcomes.
    Summary: Careful needs assessment, selection of the correct digital health solution, and appropriate clinical validation of the benefits while avoiding additional health disparities are moral, professional, and ethical obligations for all individuals using these healthcare tools, including clinicians, data scientists, and administrators.
    MeSH term(s) Adult ; Humans ; Child ; Artificial Intelligence ; Delivery of Health Care ; Acute Kidney Injury/therapy ; Physicians
    Language English
    Publishing date 2023-10-03
    Publishing country United States
    Document type Review ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000001105
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Cautious Optimism: Artificial Intelligence and Acute Kidney Injury.

    Bajaj, Tushar / Koyner, Jay L

    Clinical journal of the American Society of Nephrology : CJASN

    2023  

    Language English
    Publishing date 2023-01-30
    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.0000000000000088
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Subclinical Acute Kidney Injury Is Acute Kidney Injury and Should Not Be Ignored.

    Koyner, Jay L

    American journal of respiratory and critical care medicine

    2020  Volume 202, Issue 6, Page(s) 786–787

    MeSH term(s) Acute Kidney Injury/diagnosis ; Creatinine ; Critical Illness ; Humans ; Incidence
    Chemical Substances Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2020-07-08
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202006-2239ED
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Artificial Intelligence in Acute Kidney Injury Prediction.

    Bajaj, Tushar / Koyner, Jay L

    Advances in chronic kidney disease

    2022  Volume 29, Issue 5, Page(s) 450–460

    Abstract: The use of artificial intelligence (AI) in nephrology and its associated clinical research is growing. Recent years have seen increased interest in utilizing AI to predict the development of hospital-based acute kidney injury (AKI). Several AI techniques ...

    Abstract The use of artificial intelligence (AI) in nephrology and its associated clinical research is growing. Recent years have seen increased interest in utilizing AI to predict the development of hospital-based acute kidney injury (AKI). Several AI techniques have been employed to improve the ability to detect AKI across a variety of hospitalized settings. This review discusses the evolutions of AKI risk prediction discussing the static risk assessment models of yesteryear as well as the more recent trend toward AI and advanced learning techniques. We discuss the relative improvement in AKI detection as well as the relative dearth of data around the clinical implementation and patient outcomes using these models. The use of AI for AKI detection and clinical care is in its infancy, and this review describes how we arrived at our current position and hints at the promise of the future.
    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/therapy ; Artificial Intelligence ; Hospitalization ; Humans ; Nephrology ; Risk Assessment
    Language English
    Publishing date 2022-10-17
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ISSN 1548-5609 ; 1548-5595
    ISSN (online) 1548-5609
    ISSN 1548-5595
    DOI 10.1053/j.ackd.2022.07.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Biomarker Enrichment in Sepsis-Associated Acute Kidney Injury: Finding High-Risk Patients in the Intensive Care Unit.

    Baeseman, Louis / Gunning, Samantha / Koyner, Jay L

    American journal of nephrology

    2023  Volume 55, Issue 1, Page(s) 72–85

    Abstract: Background: Sepsis-associated acute kidney injury (AKI) is a leading comorbidity in admissions to the intensive care unit. While a gold standard definition exists, it remains imperfect and does not allow for the timely identification of patients in the ... ...

    Abstract Background: Sepsis-associated acute kidney injury (AKI) is a leading comorbidity in admissions to the intensive care unit. While a gold standard definition exists, it remains imperfect and does not allow for the timely identification of patients in the setting of critical illness. This review will discuss the use of biochemical and electronic biomarkers to allow for prognostic and predictive enrichment of patients with sepsis-associated AKI over and above the use of serum creatinine and urine output.
    Summary: Current data suggest that several biomarkers are capable of identifying patients with sepsis at risk for the development of severe AKI and other associated morbidity. This review discusses these data and these biomarkers in the setting of sub-phenotyping and endotyping sepsis-associated AKI. While not all these tests are widely available and some require further validation, in the near future we anticipate several new tools to help nephrologists and other providers better care for patients with sepsis-associated AKI.
    Key messages: Predictive and prognostic enrichment using both traditional biomarkers and novel biomarkers in the setting of sepsis can identify subsets of patients with either similar outcomes or similar pathophysiology, respectively. Novel biomarkers can identify kidney injury in patients without consensus definition AKI (e.g., changes in creatinine or urine output) and can predict other adverse outcomes (e.g., severe consensus definition AKI, inpatient mortality). Finally, emerging artificial intelligence and machine learning-derived risk models are able to predict sepsis-associated AKI in critically ill patients using advanced learning techniques and several laboratory and vital sign measurements.
    MeSH term(s) Humans ; Artificial Intelligence ; Biomarkers ; Intensive Care Units ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Sepsis/complications ; Sepsis/urine ; Critical Illness ; Creatinine
    Chemical Substances Biomarkers ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2023-10-16
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 604540-6
    ISSN 1421-9670 ; 0250-8095
    ISSN (online) 1421-9670
    ISSN 0250-8095
    DOI 10.1159/000534608
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Intraoperative Renal Replacement Therapy in Orthotopic Liver Transplantation.

    Bohorquez, Humberto / Koyner, Jay L / Jones, Courtney R

    Advances in kidney disease and health

    2023  Volume 30, Issue 4, Page(s) 378–386

    Abstract: Acute kidney injury in patients admitted to the hospital for liver transplantation is common, with up to 80% of pretransplant patients having some form of acute kidney injury. Many of these patients start on dialysis prior to their transplant and have it ...

    Abstract Acute kidney injury in patients admitted to the hospital for liver transplantation is common, with up to 80% of pretransplant patients having some form of acute kidney injury. Many of these patients start on dialysis prior to their transplant and have it continued intraoperatively during their surgery. This review discusses the limited existing literature and expert opinion around the indications and outcomes around intraoperative dialysis (intraoperative renal replacement therapy) during liver transplantation. More specifically, we discuss which patients may benefit from intraoperative renal replacement therapy and the impact of hyponatremia and hyperammonemia on the dialysis prescription. Additionally, we discuss the complex interplay between anesthesia and intraoperative renal replacement therapy and how the need for clearance and ultrafiltration changes throughout the different phases of the transplant (preanhepatic, anhepatic, and postanhepatic). Lastly, this review will cover the limited data around patient outcomes following intraoperative renal replacement therapy during liver transplantation as well as the best evidence for when to stop dialysis.
    MeSH term(s) Humans ; Liver Transplantation/adverse effects ; Renal Dialysis ; Continuous Renal Replacement Therapy ; Renal Replacement Therapy ; Acute Kidney Injury/etiology
    Language English
    Publishing date 2023-08-30
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 3156601-7
    ISSN 2949-8139
    ISSN (online) 2949-8139
    DOI 10.1053/j.akdh.2023.03.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Extracorporeal Blood Purification Is Appropriate in Critically Ill Patients with COVID-19 and Multiorgan Failure: COMMENTARY.

    Ostermann, Marlies / Koyner, Jay L

    Kidney360

    2021  Volume 3, Issue 3, Page(s) 423–425

    MeSH term(s) COVID-19 ; Critical Illness/therapy ; Humans ; Multiple Organ Failure/etiology ; SARS-CoV-2
    Language English
    Publishing date 2021-08-19
    Publishing country United States
    Document type Journal Article ; Comment
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0005242021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Urine Sediment Exam Provides More Diagnostic Information in AKI than Novel Urinary Biomarkers: CON.

    La, Ashley / Koyner, Jay L

    Kidney360

    2021  Volume 3, Issue 4, Page(s) 600–603

    MeSH term(s) Acute Kidney Injury/diagnosis ; Biomarkers ; Humans ; Urinalysis
    Chemical Substances Biomarkers
    Language English
    Publishing date 2021-09-09
    Publishing country United States
    Document type Journal Article
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0004582021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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